Pharmacy Reimbursement Specialist Prior Authorization Expert

VCU Health; Richmond (VA); On-site; USD 55,000 - 65,000; Full time

Job summary

VCU Health is seeking a Reimbursement Specialist to enhance revenue capture for high-cost medications needing prior authorizations. You will initiate, track, and finalize approvals or denials by phone, fax, or electronic methods, and coordinate patient assistance programs and copay cards.

Responsibilities include arranging refills/transfers, delivering medications, and updating the patient management system.

Qualifications

• Must hold VA Pharmacy license and PTCB certification.
• One year of pharmacy practice experience in a similar setting.
• Three years of experience with Manufacturers Patient Assistance Programs and prior online prescription adjudication.

Responsibilities

• Improve revenue collection for high-cost medications requiring prior authorization.
• Initiate, follow-up, and process prior authorizations via phone, fax, or electronic submission.
• Coordinate patient assistance programs and copay cards; liaise with nursing and physicians for documentation.
• Arrange refills, transfers, and delivery; update patient management system regularly.
• May perform pharmacy technician duties as needed.

Skills

Prior Authorization

Customer Service

Billing software usage

Education

High School Diploma or equivalent

Associate's Degree in Business or related field

Tools

PTCB certification

Virginia State Board of Pharmacy licensure

Billing software, email, spreadsheets, word processing, databases

Job description

VCU Health is seeking a Reimbursement Specialist to enhance revenue capture for high-cost medications needing prior authorizations. You will initiate, track, and finalize approvals or denials by phone, fax, or electronic methods, and coordinate patient assistance programs and copay cards.

Responsibilities include arranging refills/transfers, delivering medications, and updating the patient management system.