Specialist - Field Reimbursement
About The Position
The Field Reimbursement Specialist (FRS) is 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 complex insurance and reimbursement processes and by resolving access barriers. FRSs serve as liaisons between providers, manufacturers, pharmacies, and payers. They meet with healthcare providers and office staff to explain reimbursement and access considerations for specialty medications. Expertise in pharmacy benefit reimbursement, prior authorizations, appeals, and specialty pharmacies is essential because the supported medication is typically covered under pharmacy benefits. The position involves weekly travel, potentially including overnight stays, to healthcare offices within a designated territory that includes Indiana, Michigan, and Illinois, among other possible locations. Candidates must live within a reasonable commuting distance of a major airport in the listed location and be able to travel up to 50% within the territory.
Requirements
- High school diploma or GED.
- 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.
- Must live within a reasonable commuting distance of a major airport in the listed location and be able to travel within the territory, which includes but may not be limited to Indiana, Illinois, and Michigan.
- Must be willing 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 healthcare providers and 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 product and communicate important coverage and payer policy changes in assigned territories.
- Explain payers’ coverage management strategies, including coding, billing, formulary, prior authorization, and appeal processes.
- Assess 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 client products, subject to 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.
- 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
Career Level
Mid Level
Education Level
High school or GED
