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 prior authorization approvals and denials through phone, fax, or electronic systems.

• Perform benefit investigations.

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

• Collaborate closely with nursing staff and physicians to gather necessary documentation for prior authorization and billing purposes.

• Organize medication refills, transfers, and deliveries.

• Regularly update the patient case management system.

• Research relevant disease-state terminology as required.

• Function as a Pharmacy Technician when necessary.

• Identify issues related to equipment.

• Assist the pharmacist with tasks that do not require their supervision or verification.

⛳️ Requirements

• Must possess a current Virginia Pharmacy license and PTCB certification.

• Valid certification from the Pharmacy Technician Certification Board (PTCB).

• Active licensure with the Virginia State Board of Pharmacy.

• Clean criminal history with no felony convictions or drug/pharmacy-related offenses, including misdemeanors.

• No denials, suspensions, revocations, or restrictions on registration or licensure by any State Board of Pharmacy.

• Minimum of one (1) year of prior pharmacy practice experience in a similar environment.

• At least three (3) years of experience with Manufacturers Patient Assistance Programs.

• Previous experience with online adjudication of prescriptions.

• Familiarity with personal computers, billing software applications, email, spreadsheets, word processing, databases, and similar tools.

• High School Diploma or equivalent.

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

• Physical capability to lift less than 20 lbs.

• Ability to engage in prolonged standing and sitting, frequent bending, walking, climbing, extensive reaching, and repetitive motion.

• Strong skills in recall, reasoning, problem solving, hearing, clear speaking, legible writing, reading, and logical thinking.

• Capacity to thrive in a fast-paced, steady-paced, and noisy environment; manage multiple priorities and frequent/intense customer interactions; and adapt to frequent changes.

🏝️ Benefits

• Competitive salary and benefits package.

• Opportunities for professional development and growth.

• Supportive work environment with a focus on teamwork.