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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 of previous pharmacy practice experience in a similar setting
Minimum of three (3) years of 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:
Associate's 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 change
EEO Employer/Disabled/Protected Veteran
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