The Reimbursement Specialist Supervisor oversees the daily operations of the Reimbursement Specialist team to ensure timely and accurate processing of prior authorizations, insurance follow-ups, and patient assistance program requests pertaining to high-cost medications that require prior authorization. This role provides guidance, coaching, and performance management for team members, while supporting workflow optimization and departmental revenue collection goals.
Essential Job Statements
Supervise, coordinate, and prioritize the workflow of Reimbursement Specialists across multiple clinics.
Provide direct line supervision for Reimbursement Specialists, including performance evaluations, disciplinary action, time/attendance, coordination of staff activities, or other work as needed. Conduct hiring, interviewing, onboarding, and training of new employees.
Monitor team productivity and compliance with turnaround times, providing feedback and coaching as needed.
Facilitate training and onboarding of new Reimbursement Specialists.
Review complex or escalated prior authorizations and appeals, ensuring appropriate documentation and
compliance with insurance and regulatory requirements.
Collaborate with providers, nursing staff, and the Patient Assistance Program (PAP) team to ensure patients receive timely access to medications.
Identify process improvements to optimize team efficiency and patient care outcomes.
Prepare and review reports on team performance, Patient Assistance (PA) approvals/denials, and workload metrics.
Ensure compliance with departmental and health system policies and regulatory requirements.
Participate in special projects and cross-functional initiatives as assigned.
Serve as a point of contact for internal and external escalations related to PAs, appeals, or patient access concerns.
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 supervisory or leadership certifications a plus
Minimum Qualifications
Years and Type of Required Experience ·
Minimum of three (3) years of experience as a Reimbursement Specialist or equivalent role
Previous experience supervising or mentoring staff
Other Knowledge, Skills and Abilities Required:
Strong knowledge of PAPs, prior authorizations, and insurance benefit investigations
Proficiency in EMR systems and Microsoft Office
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
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