Reimbursement Specialist Senior - Remote

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 equivalent

Preferred Education:

Associate's Degree or higher in Business, Healthcare Administration, or related field

Licensure/Certification Required:

Current certification by the Pharmacy Technician Certification Board (PTCB) Current licensure with the Virginia State Board of Pharmacy

Licensure/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 role

Demonstrated ability to handle complex PAs, appeals, and PAP cases

Other Knowledge, Skills and Abilities Required:

Strong problem-solving, analytical, and communication skills

Ability to handle multiple priorities in a fast-paced environment

Cultural Responsiveness

Other Knowledge, Skills and Abilities Preferred:

Strong leadership and communication skills

Ability 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.), Bending

Work 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 - near

Hazards:

Mental/Sensory -Emotional

Mental / Sensory: Strong Recall, Reasoning, Problem Solving, Hearing, Speak Clearly, Write Legibly, Reading, Logical Thinking

Emotional: Fast-paced environment, Steady Pace, Able to Handle Multiple Priorities, Frequent and Intense Customer Interactions, Noisy Environment, Able to Adapt to Frequent Change

EEO Employer/Disabled/Protected Veteran/41 CFR 60-1.4.