Senior Field Reimbursement Specialist

• 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
• 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
• 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

• 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
• 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
• 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 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

Experience within healthcare provider support such as a physician practice, patient assistance program or similar pharmaceutical/biological support program experience preferred

• medical
• dental
• vision care
• comprehensive suite of benefits that focus on the physical, emotional, financial, and social aspects of wellness
• support for working families
• backup dependent care
• adoption assistance
• infertility coverage
• family building support
• behavioral health solutions
• paid parental leave
• paid caregiver leave
• training programs
• professional development resources
• opportunities to participate in mentorship programs
• employee resource groups
• volunteer activities