Field Reimbursement Specialist

This is a fully remote position, open to applicants in North Carolina, +1 more state.

📋 Description

• Act as a subject-matter expert regarding reimbursement, access, and coverage matters

• Provide education to healthcare providers, office personnel, and practice managers about insurance, reimbursement, coding, billing, formulary, prior authorization, and appeals processes

• Facilitate patient access to client products by addressing reimbursement and coverage challenges

• Collaborate with patient assistance and reimbursement support services

• Serve as a liaison among providers, manufacturers, pharmacies, and payers

• Investigate office processes to pinpoint root causes of access or reimbursement challenges

• Conduct interactive educational presentations at provider locations

• Supply approved reimbursement information concerning client products

• Update office staff regarding coverage and payer policy modifications

• Travel weekly, with potential overnight stays, to healthcare facilities within the designated territory

• Carry out other related responsibilities as assigned

⛳️ Requirements

• High School Diploma/GED is required

• Bachelor’s degree or relevant practice management experience is preferred

• Prior experience as a Field Reimbursement Manager/Specialist is preferred

• Previous experience in healthcare directly resolving pharmacy benefit access issues is preferred

• Experience with extensive travel is necessary

• Familiarity with revenue cycle, formulary, benefit investigations, prior authorization, coding, and appeals processes is required

• In-depth knowledge of pharmacy benefits/policies is essential

• Understanding of specialty pharmacy dynamics is important

• Proficiency in Microsoft Word, PowerPoint, Excel, and Outlook is required

• Ability to provide field-based reimbursement and access support, education, and consultation is necessary

• Strong time management and planning abilities are essential

• Must reside within a reasonable commuting distance of a major airport in the specified location

• Willingness to travel up to 80% within a territory that includes Georgia, North Carolina, and South Carolina is required

• Willingness to obtain a Prior Authorization Certified Specialist (PACS) certification within the first six months of employment is necessary

🏝️ Benefits

• Medical, dental, and vision coverage

• Backup dependent care

• Adoption assistance

• Coverage for infertility

• Support for family building

• Solutions for behavioral health

• Paid parental leave

• Paid caregiver leave

• Training programs

• Resources for professional development

• Mentorship opportunities

• Employee resource groups

• Volunteer activities