Senior Field Reimbursement Specialist

Cencora

4d

About The Position

Under general supervision of a Senior Manager, the Sr Field Reimbursement Specialist (Regional FRM Lead) will plan and engage with customers, leveraging client approved resources, to educate on access and reimbursement topics relevant to assigned client’s product. Track progress and evaluate results of assigned activities. Recommends changes in procedures. Lead or direct more complex projects or certain aspects of projects. Operates with reasonable latitude for un-reviewed action or decision, requiring minimum correction on final review of work product. The Sr FRS/Regional Lead will work within a matrix environment to collaborate with internal and external stakeholders to secure optimized patient access and provide appropriate education through a focused effort on healthcare providers in community, institutional, and academic medical settings. Manage daily activities that support appropriate patient access to our client’s products in the provider offices and healthcare institutions, working as a liaison to other patient assistance and reimbursement support services offered by our clients. The scope and approach to the activities are defined by the client’s legal and compliance departments and may vary. Activities may include, but are not limited to: Review patient insurance benefit options with appropriate authorizations Validate prior authorization requirements Understanding of Specialty Pharmacy processes Educate provider office staff and practice managers on coordination needed to support client product, including infrastructure needed to support in-office administration including buy and bill and monitoring of product, and important coverage and payer policy changes within assigned territories. Educate provider office staff with understanding the payers’ coverage management strategies for product, including coding, billing, formulary, prior authorization, and appeal processes. Identify alternate funding/financial assistance programs Act as SME about coverage, specific product codes, including patient-specific access questions. Effective account management: uncovering customer insights through effective questioning; critical thinking and problem solving; disseminating data and information to partners. Review appropriate billing and coding for products Probe to understand office processes and ability to discern root causes of access or reimbursement issues Drive resolving reimbursement issues through an educational approach Collaborate with our client’s patient services program representatives Educate physician office staff on the use of our client’s patient assistance and support line reimbursement support services, including web-based provider programs Deliver interactive educational presentations at various provider sites of service Provide information on relevant reimbursement topics related to our client’s products based on client’s approval Communicate and collaborate with client cross-functional teams to include but not limited to sales representatives, account managers and district managers based on established rules of engagement Prioritize activities and abide by processes to maximize effective coverage of accounts and track progress while adhering to policies, procedures, and performance metrics Leverage reimbursement knowledge and utilize resources to aid accounts and effectively build customer partnerships Lead internal team training and meetings Serve as a peer buddy and mentor to colleagues Lead geography support for team members and manager Develop and execute business plan for assigned territory Performs other related duties as assigned.

Requirements

• Experience related and progressively responsible in a medical practice, private or third-party reimbursement arena, or pharmaceutical industry in sales, managed care, or clinical support.
• Minimum of 7 years of experience
• Candidates must possess a Prior Authorization Certification Specialist (PACS) credentials from an industry approved licensing body, or obtain certification within the first six months of employment.
• Ability to effectively manage multiple client relationships (e.g., field sales, payer team, support services vendor representatives) and customer
• Ability to manage and support external meetings, presentations, and client interactions
• Ability to lead and work in a matrix environment
• Proven teamwork and collaboration skills with a demonstrated record of accomplishment of working in highly matrixed and cross-functional organizations
• Ability to manage multiple tasks, timelines, expenses, and other activities necessary to fulfill the roles and responsibilities of a Field Reimbursement Specialists
• Ability to effectively work with other client’s program vendors to deliver a positive customer experience
• Sound Judgment and decision-making ability with a high degree of emotional intelligence
• Creative problem-solving skills
• Ability to effectively manage competing priorities with a keen sense of urgency
• Demonstrated territory and coordination management skills
• Results oriented
• Excellent communication skills with the ability to present complex information in both informal and formal settings
• Ability to build and maintain effective relationships with business partners and healthcare professionals
• Broad understanding of the physician buy-and-bill model vs. assignment of benefits to alternate sites of care
• Deep understanding of medical and pharmacy benefits/policies
• Understands the dynamics of Specialty Pharmacy vs. Specialty Distribution
• Ensure processes are in place to drive pull through by providing education and resolution on reimbursement and access related issues
• Ability to conduct field-based reimbursement and access support, education, and consultation to key account customers and cross-functional partners
• Experience in revenue cycle, buy and bill (including billing with miscellaneous J-code), formulary, benefit investigations, prior authorization, coding, and appeals processes
• Knowledge of private payer, Medicare, and Medicaid structures, systems, processes, policies, and Utilization Management criteria
• Understanding of, and ability to, educate on pharmaceutical manufacturer patient support programs, including financial and co-payment assistance programs
• Listens and responds appropriately to customer needs and questions
• Serve as team subject matter expert on a specific topic, providing routing training to team
• Strong presentation skills, especially effective in small groups
• Above average computer skills: MS PowerPoint, MS Excel, MSWord, and MS Outlook

Nice To Haves

• Experience within healthcare provider support such as a physician practice, patient assistance program or similar pharmaceutical/biological support program experience preferred.
• Bachelor’s degree preferred.

Responsibilities

• Plan and engage with customers, leveraging client approved resources, to educate on access and reimbursement topics relevant to assigned client’s product.
• Track progress and evaluate results of assigned activities.
• Recommends changes in procedures.
• Lead or direct more complex projects or certain aspects of projects.
• Collaborate with internal and external stakeholders to secure optimized patient access and provide appropriate education through a focused effort on healthcare providers in community, institutional, and academic medical settings.
• Manage daily activities that support appropriate patient access to our client’s products in the provider offices and healthcare institutions, working as a liaison to other patient assistance and reimbursement support services offered by our clients.
• Review patient insurance benefit options with appropriate authorizations
• Validate prior authorization requirements
• Understanding of Specialty Pharmacy processes
• Educate provider office staff and practice managers on coordination needed to support client product, including infrastructure needed to support in-office administration including buy and bill and monitoring of product, and important coverage and payer policy changes within assigned territories.
• Educate provider office staff with understanding the payers’ coverage management strategies for product, including coding, billing, formulary, prior authorization, and appeal processes.
• Identify alternate funding/financial assistance programs
• Act as SME about coverage, specific product codes, including patient-specific access questions.
• Effective account management: uncovering customer insights through effective questioning; critical thinking and problem solving; disseminating data and information to partners.
• Review appropriate billing and coding for products
• Probe to understand office processes and ability to discern root causes of access or reimbursement issues
• Drive resolving reimbursement issues through an educational approach
• Collaborate with our client’s patient services program representatives
• Educate physician office staff on the use of our client’s patient assistance and support line reimbursement support services, including web-based provider programs
• Deliver interactive educational presentations at various provider sites of service
• Provide information on relevant reimbursement topics related to our client’s products based on client’s approval
• Communicate and collaborate with client cross-functional teams to include but not limited to sales representatives, account managers and district managers based on established rules of engagement
• Prioritize activities and abide by processes to maximize effective coverage of accounts and track progress while adhering to policies, procedures, and performance metrics
• Leverage reimbursement knowledge and utilize resources to aid accounts and effectively build customer partnerships
• Lead internal team training and meetings
• Serve as a peer buddy and mentor to colleagues
• Lead geography support for team members and manager
• Develop and execute business plan for assigned territory
• Performs other related duties as assigned.

Benefits

• We provide compensation, benefits, and resources that enable a highly inclusive culture and support our team members’ ability to live with purpose every day.
• In addition to traditional offerings like medical, dental, and vision care, we also provide a comprehensive suite of benefits that focus on the physical, emotional, financial, and social aspects of wellness.
• This encompasses support for working families, which may include backup dependent care, adoption assistance, infertility coverage, family building support, behavioral health solutions, paid parental leave, and paid caregiver leave.
• To encourage your personal growth, we also offer a variety of training programs, professional development resources, and opportunities to participate in mentorship programs, employee resource groups, volunteer activities, and much more.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees