Pharmacy Reimbursement Specialist

4 weeks ago


Richmond, California, United States VCU Health Full time

Job Summary:

The Pharmacy Reimbursement Specialist plays a vital role in improving revenue collection for high-cost medications that require prior authorization at VCU Health. This position is responsible for efficiently initiating, following up, and proceeding with approval and/or denials of prior authorizations via phone, fax, or electronically.

Key Responsibilities:

  • Carry out benefit investigation and coordinate Patient Assistance Programs and/or copay cards for patients with high co-pays or those without insurance coverage.
  • Work closely with nursing and physicians to obtain required documentation for prior authorization and billing.
  • Arrange refills, transfers, and delivery of medications, and update patient case management systems regularly.

Requirements:

  • Current certification by the Pharmacy Technician Certification Board (PTCB)
  • Current licensure with the Virginia State Board of Pharmacy
  • 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

Preferred Qualifications:

  • Associates Degree in Business or related field from an accredited program

Working Conditions:

  • Able to work all shifts, weekends, holidays, emergency coverage

Physical Requirements:

  • Lifting less than 20 lbs.
  • Prolonged standing, Prolonged sitting, Frequent bending, Walking (distance), Climbing (steps, ladder, other), Reaching (overhead, extensive, repetitive), Repetitive motion

Mental/Sensory Requirements:

  • Strong recall, Reasoning, Problem solving, Hearing, Speak clearly, Write legibly, Reading, Logical thinking

Emotional Requirements:

  • Fast pace environment, Steady pace, Able to handle multiple priorities, Frequent and intense customer interactions, Noisy environment, Able to adapt to frequent change


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