Field Reimbursement Specialist

About the role

The Field Reimbursement Specialist (FRS) will manage defined accounts in a specified geographic region within the ophthalmic therapeutic area, supporting our client’s products. The FRS will execute the collaborative territory strategic plan through partnership with internal and external stakeholders, including call center services (HUB), sales, market access, and other collaboration partners. Responsibilities include ensuring understanding of the reimbursement process, field reimbursement services, and patient support programs. The Reimbursement Specialist will also resolve patient-level reimbursement issues and must have experience with patient health information (PHI).

Responsibilities

• Act as an extension of the product by providing live one-on-one coverage support.
• Offer assistance from physician order to reimbursement, supporting the entire reimbursement journey through payer prior authorization, appeals, denials, requirements, procedures, and forms.
• Review patient-specific information to resolve issues or coverage challenges when requested by the site.
• Review patient insurance benefit options.
• Identify alternate funding and financial assistance programs.
• Coordinate with our client’s patient support services program representatives.
• Educate physician office staff on the use of our client’s patient assistance and call center support services, including web-based provider programs.
• Provide information on relevant reimbursement topics related to our client’s products.
• Serve as a payer expert for the defined geography and communicate changes to key stakeholders in a timely manner.
• Provide office support in accurate coding and billing for the client’s products.

Requirements

• Bachelor’s degree or a minimum of three years of experience in public or private third-party access, the pharmaceutical industry in managed care, clinical support, and/or sales, or a minimum of six years of biologic coordinator experience.
• Minimum of two years of access and reimbursement, managed care, and/or billing and coding support experience.
• Experience working with Buy and Bill products and a thorough understanding of the entire reimbursement process from script to injection.
• Ophthalmic, retina specialists, and biosimilar experience preferred.
• Experience establishing relationships within a practice to help remove reimbursement barriers to specialty products for patients.
• Knowledge of Centers for Medicare & Medicaid Services (CMS) policies and processes, with expertise in Medicare Part D (Pharmacy Benefit design and coverage policy) a plus.
• Knowledge of Managed Care, Government, and Federal payer sectors, as well as Integrated Delivery Network/Integrated Health Systems a plus.
• Ability to travel and cover large multistate geography territories; 50% travel required.
• Excellent presentation and project management skills.

Benefits

• Competitive compensation package.
• Health benefits, including Medical, Dental, and Vision.
• Company-matched 401k.
• Flexible paid time off (PTO) and sick time (eligibility may vary by location).