Reimbursement Specialist - Days - Remote

About the role

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.

Requirements

• Current certification by the Pharmacy Technician Certification Board (PTCB)
• Current licensure with the Virginia 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 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.
• High School Diploma or equivalent

Qualifications

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

Skills

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

Able to handle multiple priorities, Frequent and intense customer interactions, Able to adapt to frequent change

Physical Requirements

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: Fast pace environment, Steady pace, Noisy environment