Field Reimbursement Specialist
About The Position
The Field Reimbursement Specialist (FRS) serves as a subject-matter expert on reimbursement, access, and coverage issues. The role helps patients access specialty medications by educating healthcare providers and their staff on insurance and reimbursement processes and resolving access barriers. FRSs act as liaisons among providers, manufacturers, pharmacies, and payers, with expertise in pharmacy benefit reimbursement, prior authorizations, appeals, and specialty pharmacies. The FRS provides education on reimbursement and access considerations for a specialty medication using client-approved resources, supports appropriate patient access by addressing coverage challenges, and collaborates with the client’s patient assistance and reimbursement support services. The role involves weekly travel to healthcare offices within an assigned territory, with possible overnight stays and travel of up to 80%. Candidates must live within a reasonable commuting distance of a major airport in the listed location. The territory includes, but may not be limited to, Virginia, Washington, D.C., Kentucky, and Tennessee.
Requirements
- High school diploma or GED required.
- Previous experience working in healthcare and directly resolving pharmacy benefit access issues.
- Experience with extensive travel.
- Ability to conduct field-based reimbursement and access support, education, and consultation for key account customers and cross-functional partners.
- Understanding of specialty pharmacy dynamics.
- Experience with revenue cycle, formulary, benefit investigations, prior authorization, coding, and appeals processes.
- Deep understanding of pharmacy benefits and policies.
- Strong time management and planning skills.
- Proficiency in Microsoft Word, PowerPoint, Excel, and Outlook.
- Live within a reasonable commuting distance of a major airport in the listed location and be able to travel within the assigned territory.
- Willingness to obtain a Prior Authorization Certified Specialist (PACS) certification within the first six months of employment.
Nice To Haves
- Bachelor’s degree or relevant practice management experience.
- Previous experience as a Field Reimbursement Manager or Specialist.
Responsibilities
- Educate provider office staff and practice managers about insurance issues relevant to the supported product and communicate important coverage and payer policy changes within assigned territories.
- Explain payer coverage management strategies, including coding, billing, formulary, prior authorization, and appeals processes.
- Probe office processes and identify root causes of access or reimbursement issues.
- Deliver interactive educational presentations at provider sites of service.
- Provide information on reimbursement topics related to the client’s products, subject to client approval.
- Support appropriate patient access to the client’s products by resolving reimbursement and coverage challenges.
- Collaborate with other patient assistance and reimbursement support services offered by the client.
- Perform other related duties as assigned.
Benefits
- Medical, dental, and vision care
- Backup dependent care
- Adoption assistance
- Infertility coverage
- Family building support
- Behavioral health solutions
- Paid parental leave
- Paid caregiver leave
- Training programs
- Professional development resources
- Mentorship programs
- Employee resource groups
- Volunteer activities
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
