Field Reimbursement Specialist

The Field Reimbursement Specialist (FRS) serves as a subject-matter expert on reimbursement, access, and coverage issues. The FRS play a critical role in ensuring patients can access specialty medications by educating healthcare providers and their staff on complex insurance and reimbursement processes and resolving access barriers. In this role, FRSs act as liaisons between providers, manufacturers, pharmacies, and payers to navigate reimbursement challenges. They meet directly with healthcare providers and their office staff to provide education on the reimbursement and access considerations specific to a specialty medication. For this position, expertise in pharmacy benefit reimbursement, prior authorizations, appeals, and specialty pharmacies is essential, as the supported medication is typically covered under pharmacy benefits.

Responsibilities

Educating providers and their office staff on access and reimbursement topics using client-approved resources; Supporting appropriate patient access to the client's products by resolving reimbursement and coverage challenges; Collaborating with other patient assistance and reimbursement support services offered by the client; Educating provider office staff and practice managers on insurance issues relevant to the supported client's product and informing staff of important coverage and payer policy changes within assigned territories; Educating provider office staff on payers' coverage management strategies, including coding, billing, formulary, prior authorization, and appeal processes; Probing to understand office processes and discern root causes of access or reimbursement issues; Delivering interactive educational presentations at various provider sites of service; Providing information on relevant reimbursement topics related to the client's products based on client approval; Performing other related duties as assigned

Requirements

High School Diploma/GED; Ability to conduct field-based reimbursement and access support, education, and consultation to key account customers and cross-functional partners; Understands the dynamics of specialty pharmacy; 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; Proficient in Microsoft Word, Powerpoint, Excel, and Outlook; Live within a reasonable commuting distance of a major airport in the listed location; Able to travel up to 50% within a territory that includes but may not be limited to Indiana, Illinois and Michigan; Experience with extensive travel; Willing to obtain a Prior Authorization Certified Specialist (PACS) certification within the first six months of employment

Nice to have

Bachelor's degree or relevant practice management experience; Previous experience as Field Reimbursement Manager/Specialist; Previous experience working in healthcare directly resolving pharmacy benefit access issues

Benefits

Medical, dental, and vision care; Comprehensive wellness benefits covering physical, emotional, financial, and social aspects; 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