Field Reimbursement Specialist
$93,500–$187,000 year
RemoteUtah, United States or El Paso, Texas, United States
Job Summary
Educate provider office staff and practice managers on insurance issues, coverage policies, and payer strategies including coding, billing, formulary, prior authorization, and appeal processes. Resolve reimbursement and access barriers by collaborating with patient assistance services and navigating challenges between providers, manufacturers, pharmacies, and payers. Probe office processes to discern root causes of access issues and deliver interactive educational presentations at various sites of service. This role requires weekly travel, including potential overnight stays, within a designated territory covering Colorado, Utah, Eastern Washington, Montana, Idaho, New Mexico, West Texas, Oklahoma, and Wyoming. Candidates must obtain a Prior Authorization Certified Specialist (PACS) certification within six months.
Required Qualifications
- Live within a reasonable commuting distance of a major airport in the listed location
- Be able to travel up to 80% within a territory that includes but may not be limited to Colorado, Utah, Eastern Washington, Montana, Idaho, New Mexico, West Texas, Oklahoma, and Wyoming
- High School Diploma/GED
- Ability to conduct field-based reimbursement and access support, education, and consultation to key account customers and cross-functional partners
- 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
- Previous experience working in healthcare directly resolving pharmacy benefit access issues
- Experience with extensive travel
- Willingness to obtain a Prior Authorization Certified Specialist (PACS) certification within the first six months of employment
Desired Qualifications
- Bachelor's degree or relevant practice management experience
- Previous experience as Field Reimbursement Manager/Specialist
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