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Field Reimbursement Specialist

2 months ago

New Orleans, Louisiana, United States RemX Full time
Job Overview

Field Reimbursement Specialist position available, focusing on the Gulf regions including Louisiana, Mississippi, and Alabama.

This role involves traveling within your designated territory, engaging with healthcare providers three days a week.

Essential Qualifications:

  • Proficient in Prior Authorizations for Specialty Medications, Access and Reimbursement, and Patient Access to therapeutic solutions.
  • Experience in field operations, managing a territory effectively.

Key Responsibilities:

  • Deliver tailored education (both in-person and virtual) to healthcare office staff regarding reimbursement challenges and available support services for specialty medications.
  • Guide provider office teams through:
    • Benefit Investigations and Prior Authorization processes for specialty medications.
    • Utilization of CoverMyMeds, including training sessions.
    • Support Center Services (hub) and coverage options.
    • Patient communication strategies.
  • Provide comprehensive reimbursement support, including:
    • Drug Therapy Case Management.
    • Billing and coding updates.
    • Claims submission processes.
    • Specialty Pharmacy interactions.
    • Medical Benefit Interpretation and understanding medical necessity.
    • Claims and appeal assistance.
    • Information on co-pay and patient assistance programs.
  • Manage your territory by making outbound calls to schedule appointments with targeted offices.
  • Conduct both in-person and virtual meetings with physician office staff and manufacturer representatives to gather and share patient and provider-specific information.
  • Assist in resolving backlog casework and monitor program performance according to established expectations.
  • Research and compile specific information for reimbursement databases.
  • Travel is primarily scheduled for Tuesdays, Wednesdays, and Thursdays, with a focus on in-person visits.

Minimum Requirements:

  • Stable environment for experienced Field Reimbursement Specialists.
  • Field or territory experience is essential for this role.
  • BA degree or relevant experience is valued.
  • 4-5 years of experience in specialty drug reimbursement and advocacy.
  • Background in medical reimbursement, particularly within Specialty Pharmacy.
  • Experience with biologics coordination, insurance verification, prior authorizations, and claims adjudication.
  • Familiarity with Medicare and commercial insurance coverage.
  • Ability to manage multiple priorities in a dynamic environment.
  • Strong computer skills, including proficiency in MS Teams, PowerPoint, and virtual meeting platforms.

Company Overview:

RemX is a leading professional staffing division that specializes in connecting talent with opportunities. Our recruiters are experts in their fields, dedicated to making the right match between candidates and companies for long-term success. We are committed to equal opportunity employment and evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.