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Cencora · 2 days ago

Senior Field Reimbursement Specialist

New York, United States

Full-time

Onsite

Mid, Senior Level

$101K/yr - $155K/yr

7+ years exp

Cencora is an innovative company focused on creating healthier futures. The Senior Field Reimbursement Specialist will engage with customers to educate them on access and reimbursement topics, manage daily activities that support patient access to products, and collaborate with various stakeholders to optimize patient access.

Emergency MedicineEnterprise SoftwareHealth CareMedicalPharmaceutical

Responsibilities

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

Qualification

Prior Authorization CertificationSpecialty Pharmacy knowledgeRevenue cycle managementMedical benefits understandingClient relationship managementPresentation skillsProblem-solving skillsTeam collaborationCritical thinkingEffective communicationTime managementEmotional intelligence

Required

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

Minimum of 7 years of experience

Candidates must possess a Prior Authorization Certification Specialist (PACS) credentials from an industry approved licensing body, or obtain certification within the first six months of employment

Ability to effectively manage multiple client relationships (e.g., field sales, payer team, support services vendor representatives) and customer

Ability to manage and support external meetings, presentations, and client interactions

Ability to lead and work in a matrix environment

Proven teamwork and collaboration skills with a demonstrated record of accomplishment of working in highly matrixed and cross-functional organizations

Ability to manage multiple tasks, timelines, expenses, and other activities necessary to fulfill the roles and responsibilities of a Field Reimbursement Specialists

Ability to effectively work with other client's program vendors to deliver a positive customer experience

Sound Judgment and decision-making ability with a high degree of emotional intelligence

Creative problem-solving skills

Ability to effectively manage competing priorities with a keen sense of urgency

Demonstrated territory and coordination management skills

Results oriented

Excellent communication skills with the ability to present complex information in both informal and formal settings

Ability to build and maintain effective relationships with business partners and healthcare professionals

Broad understanding of the physician buy-and-bill model vs. assignment of benefits to alternate sites of care

Deep understanding of medical and pharmacy benefits/policies

Understands the dynamics of Specialty Pharmacy vs. Specialty Distribution

Ensure processes are in place to drive pull through by providing education and resolution on reimbursement and access related issues

Ability to conduct field-based reimbursement and access support, education, and consultation to key account customers and cross-functional partners

Experience in revenue cycle, buy and bill (including billing with miscellaneous J-code), formulary, benefit investigations, prior authorization, coding, and appeals processes

Knowledge of private payer, Medicare, and Medicaid structures, systems, processes, policies, and Utilization Management criteria

Understanding of, and ability to, educate on pharmaceutical manufacturer patient support programs, including financial and co-payment assistance programs

Listens and responds appropriately to customer needs and questions

Serve as team subject matter expert on a specific topic, providing routing training to team

Strong presentation skills, especially effective in small groups

Above average computer skills: MS PowerPoint, MS Excel, MSWord, and MS Outlook

Preferred

Experience within healthcare provider support such as a physician practice, patient assistance program or similar pharmaceutical/biological support program experience preferred

Bachelor's degree preferred