Reimbursement Specialist

Job Description:

• Improve revenue collection for high-cost medications requiring prior authorization
• Initiate, follow up on, and process prior authorization approvals and denials via phone, fax, or electronic systems
• Conduct benefit investigations
• Coordinate Patient Assistance Programs and copay cards for patients with high copays or no insurance coverage
• Work closely with nursing and physicians to obtain documentation for prior authorization and billing
• Arrange medication refills, transfers, and deliveries
• Regularly update the patient case management system
• Research disease-state terminology as needed
• Work as a Pharmacy Technician when necessary
• Identify equipment problems
• Assist the pharmacist with tasks that do not require pharmacist supervision or checking

Requirements:

• Must have both a current Virginia Pharmacy license and PTCB certification
• Current certification by the Pharmacy Technician Certification Board (PTCB)
• Current licensure with the Virginia State Board of Pharmacy
• Clean criminal record with no felony conviction or drug/pharmacy-related convictions, including misdemeanors
• No denial, suspension, revocation, or restriction of registration or licensure by any State Board of Pharmacy
• 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
• Prior experience with prescription online adjudication
• Previous experience using a personal computer, billing software applications, email, spreadsheets, word processing, databases, and similar tools
• High School Diploma or equivalent
• Able to work all shifts, weekends, holidays, and emergency coverage
• Physical ability to lift less than 20 lbs.
• Ability to perform prolonged standing and sitting, frequent bending, walking, climbing, overhead/extensive/repetitive reaching, and repetitive motion
• Strong recall, reasoning, problem solving, hearing, clear speaking, legible writing, reading, and logical thinking
• Ability to work in a fast-paced, steady-paced, noisy environment; handle multiple priorities and frequent/intense customer interactions; and adapt to frequent change