Reimbursement Specialist

VCU Health

. Improve revenue collection for high-cost medications requiring prior authorization .

Posted 10/22/2026full-timeRemote • Virginia • United StatesMid-LevelSenior💰 $20 - $31 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing prior authorization processes for high-cost medications, coordinating patient assistance programs, and utilizing pharmacy management systems. Holds necessary certifications and licenses while effectively collaborating with healthcare professionals in a fast-paced environment.

Highest-signal resume keywords

Virginia Pharmacy LicensePTCB CertificationPatient Assistance Programs ExperiencePrescription Online AdjudicationPharmacy Practice Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Prior Authorization ProcessingBenefit InvestigationsMedication Refill CoordinationPharmacy Management SystemsBilling Software ApplicationsDatabase ManagementWord ProcessingSpreadsheetsElectronic CommunicationDisease-State Terminology Research

Soft Skills

Problem SolvingClear SpeakingLogical ThinkingStrong RecallAdaptability

Certifications & Qualifications

Virginia Pharmacy LicensePTCB Certification

Industry Keywords

Pharmacy TechnicianPatient Assistance ProgramsPrior AuthorizationHigh-Cost MedicationsPharmacy Practice

About the role

Key responsibilities & impact

Improve revenue collection for high-cost medications requiring prior authorization
Initiate, follow up on, and process prior authorization approvals and denials via phone, fax, or electronic systems
Conduct benefit investigations
Coordinate Patient Assistance Programs and copay cards for patients with high copays or no insurance coverage
Work closely with nursing and physicians to obtain documentation for prior authorization and billing
Arrange medication refills, transfers, and deliveries
Regularly update the patient case management system
Research disease-state terminology as needed
Work as a Pharmacy Technician when necessary
Identify equipment problems
Assist the pharmacist with tasks that do not require pharmacist supervision or checking

Requirements

What you’ll need

Must have both a current Virginia Pharmacy license and PTCB certification
Current certification by the Pharmacy Technician Certification Board (PTCB)
Current licensure with the Virginia State Board of Pharmacy
Clean criminal record with no felony conviction or drug/pharmacy-related convictions, including misdemeanors
No denial, suspension, revocation, or restriction of registration or licensure by any 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
Prior experience with prescription online adjudication
Previous experience using a personal computer, billing software applications, email, spreadsheets, word processing, databases, and similar tools
High School Diploma or equivalent
Able to work all shifts, weekends, holidays, and emergency coverage
Physical ability to lift less than 20 lbs.
Ability to perform prolonged standing and sitting, frequent bending, walking, climbing, overhead/extensive/repetitive reaching, and repetitive motion
Strong recall, reasoning, problem solving, hearing, clear speaking, legible writing, reading, and logical thinking
Ability to work in a fast-paced, steady-paced, noisy environment; handle multiple priorities and frequent/intense customer interactions; and adapt to frequent change