Reimbursement Specialist, Specialty Pharmacy
Company: VCU Health
Location: Richmond
Posted on: January 26, 2023
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Job Description:
The Reimbursement Specialist improves revenue collection
pertaining to high cost medications that require prior
authorization. This job will initiate, follow-up, and proceed with
approval and/or denials of prior authorizations efficiently via
phone, fax, or electronically. The Reimbursement Specialist carries
out benefit investigation and coordinates Patient Assistance
Programs and/or copay cards for patients with high co-pays or those
without insurance coverage. This role works closely with nursing
and physicians in order to obtain required documentation for prior
authorization and billing. The Reimbursement Specialist arranges
refills, transfers, and delivery of medications. Updates patient
case management system regularly. Ideally, this role is familiar
with disease state terminology or willingness to research. This
role also works as a Pharmacy Technician when deemed
necessary.Licensure, Certification, or Registration Requirements
for Hire: Current certification by the Pharmacy Technician
Certification Board (PTCB) Current licensure with the Virginia
State Board of Pharmacy By virtue of societal trust and security
explicitly imparted to pharmacies for the control of drugs,
candidate/incumbent must have a clean criminal record (i.e. no
felony conviction; no drug or pharmacy related convictions,
including misdemeanors); no denial, suspension, revocation, or
restriction of registration or licensure by any State Board of
Pharmacy Licensure, Certification, or Registration Requirements for
continued employment: Current certification by the Pharmacy
Technician Certification Board (PTCB) Current licensure with the
Virginia State Board of Pharmacy Experience REQUIRED: Minimum of
one (1) year previous pharmacy practice experience in a similar
setting Minimum of three (3) years prior experience with
Manufacturers Patient Assistance Programs and prior experience with
prescription on-line adjudication Previous work experience using a
personal computer and various billing software applications as well
as e-mail, spreadsheets, word processing, databases, etc.
Experience PREFERRED: N/A Education/training REQUIRED: High School
Diploma or equivalent Education/training PREFERRED: Associates
Degree in Business or related field from an accredited program
Independent action(s) required: Identifies equipment problems;
various aspects of assisting the pharmacist that don't require a
pharmacist's supervision or check. Supervisory responsibilities (if
applicable): N/A Additional position requirements: Able to work all
shifts, weekends, holidays, emergency coverage Age Specific groups
served: N/A Physical Requirements (includes use of assistance
devices as appropriate): Physical: Lifting less than 20 lbs.
Activities: Prolonged standing, Prolonged sitting, Frequent
bending, Walking (distance), Climbing (steps, ladder, other),
Reaching (overhead, extensive, repetitive), Repetitive motion
Mental/Sensory: Strong recall, Reasoning, Problem solving, Hearing,
Speak clearly, Write legibly, Reading, Logical thinking Emotional:
Fast pace environment, Steady pace, Able to handle multiple
priorities, Frequent and intense customer interactions, Noisy
environment, Able to adapt to frequent changeEEO
Employer/Disabled/Protected Veteran/41 CFR 60-1.4.
Keywords: VCU Health, Richmond , Reimbursement Specialist, Specialty Pharmacy, Other , Richmond, Virginia
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