Field Reimbursement Specialist
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Job Description
Field Reimbursement Specialist helping U.S. healthcare providers resolve specialty medication reimbursement and access barriers. Educating office staff on pharmacy benefits, prior authorizations, appeals, and coverage policies.
Responsibilities:
- Serve as a subject-matter expert on reimbursement, access, and coverage issues
- Educate healthcare providers, office staff, and practice managers on insurance, reimbursement, coding, billing, formulary, prior authorization, and appeals processes
- Support patient access to client products by resolving reimbursement and coverage challenges
- Collaborate with client patient assistance and reimbursement support services
- Act as a liaison between providers, manufacturers, pharmacies, and payers
- Inform office staff about important coverage and payer policy changes within assigned territories
- Probe office processes and identify root causes of access or reimbursement issues
- Deliver interactive educational presentations at provider sites of service
- Provide client-approved information on reimbursement topics
- Provide territory coverage across the United States
- Perform other related duties as assigned
Requirements:
- High School Diploma/GED required
- Bachelor’s degree or relevant practice management experience preferred
- Previous experience as Field Reimbursement Manager/Specialist preferred
- Previous experience working in healthcare directly resolving pharmacy benefit access issues
- Experience with extensive travel
- Ability to conduct field-based reimbursement and access support, education, and consultation
- Understanding of specialty pharmacy dynamics
- Experience in revenue cycle, formulary, benefit investigations, prior authorization, coding, and appeals processes
- Deep understanding of pharmacy benefits/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 United States and provide territory coverage across the United States
- Willingness to obtain a Prior Authorization Certified Specialist (PACS) certification within the first six months of employment
- Willingness to travel weekly, including potential overnight stays
Benefits:
- Medical, dental, and vision care
- Backup dependent care
- Adoption assistance
- Infertility coverage
- Family building support
- Behavioral health solutions
- Paid parental leave
- Paid caregiver leave
- Training programs
- Professional development resources
- Mentorship programs
- Employee resource groups
- Volunteer activities
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