Reimbursement Specialist Senior - Remote
Virginia Commonwealth University Health, Richmond, Virginia, United States, 23214
Reimbursement Specialist Senior - Remote page is loaded## Reimbursement Specialist Senior - Remotelocations:
Richmond, VAtime type:
Full timeposted on:
Posted Todayjob requisition id:
R41813The Reimbursement Specialist Senior serves as an advanced-level specialist, handling the most complex prior authorizations, insurance appeals, and patient assistance cases pertaining to high-cost medications that require prior authorization. This role provides guidance to peers, ensures adherence to compliance and turnaround standards, and acts as a subject matter expert for the Reimbursement Specialist team.**Essential Job Statements*** Manage complex or high-priority prior authorizations and appeals across multiple clinics.* Provide guidance and mentorship to Reimbursement Specialists on best practices and workflow efficiencies.* Collaborate with providers, nursing staff, and the Patient Assistance Program (PAP) team to ensure accurate and timely access to medications.* Conduct benefit investigations and gather supporting clinical documentation for challenging cases.* Track and analyze Patient Assistance (PA) metrics, approvals, and denials to identify trends and improvement opportunities.* Assist in training new team members and provide ongoing education to peers.* Participate in special projects to improve departmental operations and patient care.* Ensure compliance with departmental and health system policies and regulatory requirements.* Serve as a point of escalation for complex PA or patient access issues.* Support the supervisor in monitoring workload distribution and workflow optimization.* Performs other duties as assigned and/or participates in special projects to support the mission of VCUHS and the Department. Provides assistance to team members. Accepts alternate assignments, as required.**Patient Population**Not applicable to this position.**Employment Qualifications**Required Education:High School Diploma or equivalentPreferred Education:Associate’s Degree or higher in Business, Healthcare Administration, or related fieldLicensure/Certification Required:Current certification by the Pharmacy Technician Certification Board (PTCB) Current licensure with the Virginia State Board of PharmacyLicensure/Certification Preferred:Additional certifications in reimbursement or pharmacy administration a plus**Minimum Qualifications**Years and Type of Required Experience ·Minimum of two (2) years of experience as a Reimbursement Specialist or equivalent roleDemonstrated ability to handle complex PAs, appeals, and PAP casesOther Knowledge, Skills and Abilities Required:Strong problem-solving, analytical, and communication skillsAbility to handle multiple priorities in a fast-paced environmentCultural ResponsivenessOther Knowledge, Skills and Abilities Preferred:Strong leadership and communication skillsAbility to handle multiple priorities and high-volume workload**Working Conditions**Periods of high stress and fluctuating workloads may occur.General office environment.May be exposed to high noise levels and bright lights.May have periods of constant interruptions.Prolonged periods of working alone.**Physical Requirements**Physical Demands: Lifting/ Carrying (0-50 lbs.), BendingWork Position: Sitting, Walking, Standing**Additional Physical Requirements/ Hazards**Physical Requirements: Manual dexterity (eye/hand coordination), Perform shift work, Hear alarms/telephone/tape recorder, Reach above shoulder, Repetitive arm/hand movements, Finger Dexterity, Color Vision, Acuity - far, Acuity - nearHazards:**Mental/Sensory –Emotional**Mental / Sensory: Strong Recall, Reasoning, Problem Solving, Hearing, Speak Clearly, Write Legibly, Reading, Logical ThinkingEmotional: Fast-paced environment, Steady Pace, Able to Handle Multiple Priorities, Frequent and Intense Customer Interactions, Noisy Environment, Able to Adapt to Frequent ChangeEEO Employer/Disabled/Protected Veteran/41 CFR 60-1.4. #J-18808-Ljbffr
Richmond, VAtime type:
Full timeposted on:
Posted Todayjob requisition id:
R41813The Reimbursement Specialist Senior serves as an advanced-level specialist, handling the most complex prior authorizations, insurance appeals, and patient assistance cases pertaining to high-cost medications that require prior authorization. This role provides guidance to peers, ensures adherence to compliance and turnaround standards, and acts as a subject matter expert for the Reimbursement Specialist team.**Essential Job Statements*** Manage complex or high-priority prior authorizations and appeals across multiple clinics.* Provide guidance and mentorship to Reimbursement Specialists on best practices and workflow efficiencies.* Collaborate with providers, nursing staff, and the Patient Assistance Program (PAP) team to ensure accurate and timely access to medications.* Conduct benefit investigations and gather supporting clinical documentation for challenging cases.* Track and analyze Patient Assistance (PA) metrics, approvals, and denials to identify trends and improvement opportunities.* Assist in training new team members and provide ongoing education to peers.* Participate in special projects to improve departmental operations and patient care.* Ensure compliance with departmental and health system policies and regulatory requirements.* Serve as a point of escalation for complex PA or patient access issues.* Support the supervisor in monitoring workload distribution and workflow optimization.* Performs other duties as assigned and/or participates in special projects to support the mission of VCUHS and the Department. Provides assistance to team members. Accepts alternate assignments, as required.**Patient Population**Not applicable to this position.**Employment Qualifications**Required Education:High School Diploma or equivalentPreferred Education:Associate’s Degree or higher in Business, Healthcare Administration, or related fieldLicensure/Certification Required:Current certification by the Pharmacy Technician Certification Board (PTCB) Current licensure with the Virginia State Board of PharmacyLicensure/Certification Preferred:Additional certifications in reimbursement or pharmacy administration a plus**Minimum Qualifications**Years and Type of Required Experience ·Minimum of two (2) years of experience as a Reimbursement Specialist or equivalent roleDemonstrated ability to handle complex PAs, appeals, and PAP casesOther Knowledge, Skills and Abilities Required:Strong problem-solving, analytical, and communication skillsAbility to handle multiple priorities in a fast-paced environmentCultural ResponsivenessOther Knowledge, Skills and Abilities Preferred:Strong leadership and communication skillsAbility to handle multiple priorities and high-volume workload**Working Conditions**Periods of high stress and fluctuating workloads may occur.General office environment.May be exposed to high noise levels and bright lights.May have periods of constant interruptions.Prolonged periods of working alone.**Physical Requirements**Physical Demands: Lifting/ Carrying (0-50 lbs.), BendingWork Position: Sitting, Walking, Standing**Additional Physical Requirements/ Hazards**Physical Requirements: Manual dexterity (eye/hand coordination), Perform shift work, Hear alarms/telephone/tape recorder, Reach above shoulder, Repetitive arm/hand movements, Finger Dexterity, Color Vision, Acuity - far, Acuity - nearHazards:**Mental/Sensory –Emotional**Mental / Sensory: Strong Recall, Reasoning, Problem Solving, Hearing, Speak Clearly, Write Legibly, Reading, Logical ThinkingEmotional: Fast-paced environment, Steady Pace, Able to Handle Multiple Priorities, Frequent and Intense Customer Interactions, Noisy Environment, Able to Adapt to Frequent ChangeEEO Employer/Disabled/Protected Veteran/41 CFR 60-1.4. #J-18808-Ljbffr