Field Reimbursement Specialist

- What you will be doing
PRIMARY DUTIES AND RESPONSIBILITIES:

- Under general supervision of a Senior Manager, the Field Reimbursement Specialist 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. May lead or direct less complex projects or certain aspects of projects. Operates with reasonable latitude for un-reviewed action or decision, but still requires final review of work product.

Manage daily activities that support appropriate patient access to our client’s products in the provider offices and work as a liaison to other patient assistance and reimbursement support services offered by our clients. 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 logistics 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-
- Review appropriate billing and coding for products-
- Probe to understand office processes and ability to discern root causes of access or reimbursement issues-
- Assist with resolving reimbursement issues through an educational approach-
- Coordinate 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-
- Serve as a peer buddy and/or mentor to colleagues-
- Develop and execute business plan for assigned territoryPerforms other related duties as assigned.
What your background should look like
EXPERIENCE AND EDUCATIONAL REQUIREMENTS:

- Experience directly 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.
- Professional experience:
Bachelor’s degree preferred.-
- Minimum of 5 years of experience- MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:
.- Ability to effectively manage multiple client relationships (e.g., field sales, payer team, support services vendor representatives) and customer-
- Proven teamwork and collaboration skills with a demonstrated track record 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 strong sense of urgency-
- Demonstrated territory and logistics 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. Special