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Field Reimbursement Specialist

2 months ago

Waltham, Massachusetts, United States Apellis Full time
Job Summary

We are seeking a highly skilled Field Reimbursement Specialist to join our team at Apellis. As a key member of our front-line field team, you will be responsible for addressing access barriers and providing education and support on our reimbursement support programs to healthcare providers and patients.

Key Responsibilities
  • Partner with internal and external stakeholders to identify and address patient and practice reimbursement issues.
  • Provide education and support on our reimbursement support programs to healthcare providers and patients.
  • Collaborate with our cross-functional teams to ensure seamless integration of our products into healthcare provider workflows.
  • Analyze reimbursement and access issues and provide insights and updates to our internal partners.
  • Communicate and explain payer policy updates or system changes that impact access to our products.
  • Proactively communicate our patient services programs, policies, and procedures to healthcare provider staff.
  • Support questions associated with patient coverage, access, and reimbursement from healthcare providers.
  • Conduct quarterly reviews with healthcare providers on their utilization of our reimbursement support services.
Requirements
  • Bachelor's degree from a four-year college or university.
  • 10 years of commercial experience in the pharmaceutical or biotech industry.
  • 5+ years of experience in healthcare coverage, coding, and/or reimbursement experience.
  • Experience with Buy and Bill products, Medicare Part B, and Miscellaneous J-Codes required.
  • Ophthalmology experience strongly preferred.
  • Start-up experience preferred.
Skills and Knowledge
  • Previous experience working with billing and medical claims personnel in various healthcare settings.
  • Shown expertise in supporting healthcare provider offices with coding, billing, and submissions in range of payer environments.
  • Well-versed with implementing and executing Medicare, Medicaid, and other payer initiatives.
  • Familiar with CPT, HCPCS, ICD-10 revenue codes.
  • Familiarity with health insurance claim forms, including UB-04, CMS-1450, CMS-1500, explanation of benefits, and prior authorization forms.
  • Ability to analyze, interpret, and understand regulatory and legislative payer and healthcare policies.
Benefits and Perks

We offer a comprehensive benefits package, including health insurance, 401K with company match, paid time off, long-term disability insurance, and life insurance. Visit our website to learn more about our company culture and benefits.