Remote Reimbursement Specialist – Prior Auth

Virginia Commonwealth University Health; Richmond, Northern (VA, KY); Hybrid; USD 48,000 - 64,000; Full time

Job summary

Virginia Commonwealth University Health is seeking a Reimbursement Specialist to improve revenue by managing prior authorizations for high-cost medications. Must have both VA Pharmacy licensure and a PTCB certification; remote work is available with Richmond, VA as a local site.

You will initiate, follow up, and adjudicate approvals or denials by phone, fax, or electronic submission, coordinate Patient Assistance Programs, arrange refills, transfers and delivery, and keep the patient case

Qualifications

• Must have both VA Pharmacy licensure and PTCB certification.
• Minimum 1 year of pharmacy practice experience in a similar setting.
• Experience with patient assistance programs and prior authorization processes.

Responsibilities

• Initiate, follow up, and adjudicate prior authorizations via phone, fax, or electronic submission.
• Coordinate patient assistance programs and copay cards for high-cost medications.
• Arrange refills, transfers, and delivery; update the patient case management system.
• Collaborate with nursing staff and physicians to obtain necessary documentation.

Skills

Prior authorization

Patient assistance programs

Billing software

Pharmacy practice

Computer skills

Education

High School Diploma or equivalent

Associate's Degree in Business or related field

Tools

Billing software

Job description

Virginia Commonwealth University Health is seeking a Reimbursement Specialist to improve revenue by managing prior authorizations for high-cost medications. Must have both VA Pharmacy licensure and a PTCB certification; remote work is available with Richmond, VA as a local site.

You will initiate, follow up, and adjudicate approvals or denials by phone, fax, or electronic submission, coordinate Patient Assistance Programs, arrange refills, transfers and delivery, and keep the patient case