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 about insurance and reimbursement processes and resolving access barriers. FRSs liaise with providers, manufacturers, pharmacies, and payers, providing education about reimbursement and access considerations for specialty medications, typically those covered under pharmacy benefits. The position involves weekly travel, potentially including overnight stays, to healthcare offices within a designated territory that may include Indiana, Michigan, and Illinois. Candidates must live within a reasonable commuting distance of a major airport in the listed location and be able to travel up to 50%. The role requires expertise in pharmacy benefit reimbursement, prior authorizations, appeals, specialty pharmacies, coverage, patient assistance, and health policy. The specialist educates office staff, addresses access challenges, and supports patients in receiving needed medications. Candidates must obtain a Prior Authorization Certified Specialist (PACS) certification within the first six months of employment.
Requirements
- High School Diploma or GED.
- Previous experience working in healthcare directly resolving pharmacy benefit access issues.
- Experience with extensive travel.
- Willingness to obtain a Prior Authorization Certified Specialist (PACS) certification within the first six months of employment.
- Ability to provide field-based reimbursement and access support, education, and consultation to key account customers and cross-functional partners.
- Understanding of specialty pharmacy dynamics.
- Experience in 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 a territory that may include Indiana, Illinois, and Michigan.
- Able to travel up to 50%, including weekly travel and potential overnight stays.
Nice To Haves
- Bachelor’s degree or relevant practice management experience.
- Previous experience as a Field Reimbursement Manager or Specialist.
Responsibilities
- Educate providers and their office staff on access and reimbursement topics using client-approved resources.
- 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.
- Educate provider office staff and practice managers about insurance issues relevant to the supported client product and communicate important coverage and payer policy changes in assigned territories.
- Explain payers’ coverage management strategies for the product, including coding, billing, formulary, prior authorization, and appeals processes.
- Understand office processes and identify root causes of access or reimbursement issues.
- Deliver interactive educational presentations at provider sites of service.
- Provide information on relevant reimbursement topics related to the client’s products based on client approval.
- Perform other related duties as assigned.
Benefits
- Medical, dental, and vision care.
- Backup dependent care may be available.
- Adoption assistance.
- Infertility coverage and family-building support.
- Behavioral health solutions.
- Paid parental leave and paid caregiver leave.
- Training programs and professional development resources.
- Mentorship programs.
- Employee resource groups.
- Volunteer activities.
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What This Job Offers
Job Type
Full-time
Education Level
High school or GED
