Pharmacy Reimbursement & Prior Authorization Specialist

VCU Health; États-Unis; À distance; USD 42 000 - 60 000; Plein temps

Résumé du poste

VCU Health is seeking a Reimbursement Specialist to optimize revenue collection for high-cost medications requiring prior authorizations. The role includes initiating and following up on authorizations via multiple channels and coordinating patient assistance programs for patients with high copays or no insurance coverage.

You will work closely with nursing and physicians to gather documentation, arrange refills and transfers, and maintain the patient management system.

Qualifications

• Minimum of one (1) year of pharmacy practice experience in a similar setting.
• Minimum of three (3) years of experience with Manufacturers Patient Assistance Programs and prior experience with prescription on-line adjudication.
• High School Diploma or equivalent.
• Associate’s Degree in Business or related field preferred.

Responsabilités

• Initiate, follow-up, and proceed with prior authorizations via phone, fax, or electronically.
• Coordinate Patient Assistance Programs and/or copay cards for patients with high co-pays or no insurance coverage.
• Arrange refills, transfers, and delivery of medications; update patient case management system regularly.
• Work closely with nursing and physicians to obtain required documentation for prior authorization and billing.
• May perform Pharmacy Technician duties when needed.

Connaissances

Prior authorization process

Patient assistance programs

Billing and adjudication

Communication

Research disease states

Formation

High School Diploma or equivalent

Associate’s Degree in Business

Outils

Billing software

Spreadsheet software

Email

Word processing

Description du poste

VCU Health is seeking a Reimbursement Specialist to optimize revenue collection for high-cost medications requiring prior authorizations. The role includes initiating and following up on authorizations via multiple channels and coordinating patient assistance programs for patients with high copays or no insurance coverage.

You will work closely with nursing and physicians to gather documentation, arrange refills and transfers, and maintain the patient management system.