Reimbursement Specialist

This is a fully remote position, open to applicants in Virginia.

📋 Description

• Enhance revenue collection for high-cost medications that necessitate prior authorization.

• Initiate, follow up, and manage the approval or denial of prior authorizations through phone, fax, or electronic systems.

• Perform benefit investigations.

• Organize Patient Assistance Programs and copay cards for patients facing high copays or lacking insurance coverage.

• Collaborate with nursing staff and physicians to secure documentation required for prior authorization and billing.

• Facilitate medication refills, transfers, and deliveries.

• Regularly update the patient case management system.

• Research disease-state terminology as necessary.

• Serve as a Pharmacy Technician when required.

• Identify equipment issues and assist the pharmacist with tasks that do not require pharmacist supervision or verification.

⛳️ Requirements

• Active Pharmacy Technician Certification Board (PTCB) certification.

• Current licensure with the Virginia State Board of Pharmacy.

• Clear criminal record with no felony convictions or drug/pharmacy-related convictions, including misdemeanors.

• No denial, suspension, revocation, or restriction of pharmacy registration or licensure.

• At least 1 year of prior pharmacy practice experience in a similar environment.

• A minimum of 3 years of experience with manufacturers' Patient Assistance Programs.

• Previous experience with online adjudication of prescriptions.

• Proficiency in using a personal computer and billing software applications.

• Familiarity with email, spreadsheets, word processing, databases, and related applications.

• Ability to work all shifts, including weekends, holidays, and emergency coverage.

• Strong skills in recall, reasoning, problem-solving, auditory comprehension, clear speech, legible writing, reading, and logical thinking.

• Capacity to manage multiple priorities, engage in frequent and intense customer interactions, and adapt to frequent changes.

• Physical capability for prolonged standing and sitting, frequent bending, walking, climbing, overhead/repetitive reaching, and repetitive motion.

• Ability to lift objects weighing less than 20 lbs.

• An Associate's Degree in Business or a related field is preferred.

🏝️ Benefits

• Full-time employment.

• EEO Employer/Disabled/Protected Veteran.