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Job Details

Under general supervision of a Senior Manager, the Sr Field Reimbursement Specialist (Regional FRM Lead) 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. Lead or direct more complex projects or certain aspects of projects. Operates with reasonable latitude for un-reviewed action or decision, requiring minimum correction on final review of work product. The Sr FRS/Regional Lead will work within a matrix environment to collaborate with internal and external stakeholders to secure optimized patient access and provide appropriate education through a focused effort on healthcare providers in community, institutional, and academic medical settings.

Manage daily activities that support appropriate patient access to our client’s products in the provider offices and healthcare institutions, working as a liaison to other patient assistance and reimbursement support services offered by our clients. The 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 coordination 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

• Act as SME about coverage, specific product codes, including patient-specific access questions.

• Effective account management: uncovering customer insights through effective questioning; critical thinking and problem solving; disseminating data and information to partners.

• Review appropriate billing and coding for products

• Probe to understand office processes and ability to discern root causes of access or reimbursement issues

• Drive resolving reimbursement issues through an educational approach

• Collaborate 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 and meetings

• Serve as a peer buddy and mentor to colleagues

• Lead geography support for team members and manager

• Develop and execute business plan for assigned territory

• Performs other related duties as assigned.

Experience and Education:

Experience 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 7 years