Field Reimbursement Specialist

Syneos Health/ inVentiv Health Commercial LLC; Buffalo (NY); On-site; USD 155,000 - 160,000; Full time

Benefits offered by this job

Health benefits

Company 401k match

Paid time off

Job summary

Syneos Health is seeking a Field Reimbursement Specialist to manage defined accounts in ophthalmology and support reimbursement processes from authorization to appeals. The role collaborates with HUB, sales, and market access teams to resolve patient reimbursement issues and educate practice staff.

The ideal candidate has 2+ years in access and reimbursement, with Buy and Bill experience, and the ability to travel across multiple states (up to 50% travel).

Qualifications

• Bachelor's degree or 3+ years in public/private third-party access or pharmaceutical industry in managed care/sales
• Minimum two years' access and reimbursement, managed care, or billing support
• Experience with Buy and Bill products and full reimbursement process from script to injection
• Ophthalmic/reimbursement/subspecialty experience preferred
• Ability to travel across large multistate territories (50% travel) and engage practice stakeholders
• Strong presentation and project management skills

Responsibilities

• Act as payer expert for defined geography and communicate changes to stakeholders
• Support reimbursement journey from prior authorization to appeals/denials
• Provide patient-level reimbursement issue resolution and PHI awareness
• Coordinate with patient support and reimbursement services
• Educate physician office staff on patient assistance and billing processes
• Assist with coding and billing accuracy for products

Skills

Reimbursement expertise

Ophthalmic experience

Public/private payer knowledge

Agency/pharma familiarity

Stakeholder collaboration

Travel readiness

Education

Bachelor's degree

3+ years managed care/pharma exposure

Tools

CMS policies knowledge

Job description

Description

The Field Reimbursement Specialist (FRS) will be responsible for the management of defined accounts in a specified geographic region in the ophthalmic therapeutic area, specifically supporting our client's products.

The FRS will execute the collaborative territory strategic plan through partnership with internal and external stakeholders, which may include call center services (HUB), sales, market access, and other collaboration partners. Responsibilities include ensuring understanding of reimbursement process, field reimbursement services, and patient support program. The Reimbursement Specialist will also work on patient‑level reimbursement issue resolution, and thus will need access to be knowledge of and have had experience with patient health information (PHI).

Field Reimbursement Specialists manage daily activities that support appropriate patient reimbursement to our client's products in the provider offices and work as a liaison to other patient assistance and reimbursement support services offered by our clients. Activities include, but are not limited to:

• Act as an extension of the product providing live one-on-one coverage support.
• Offer assistance from physician order to reimbursement, supporting the entire reimbursement journey through payer prior authorization to appeals/denials requirements procedures and forms.
• Reviewing patient-specific information in cases where the site has specifically requested the assistance in resolving any issues or coverage challenges.
• Reviewing patient insurance benefit options.
• Identifying alternate funding/financial assistance programs.
• Coordinating with our client's patient support services programs representatives.
• Educating physician office staff on the use of our client's patient assistance and call center support services, including web-based provider programs.
• Provide information on relevant reimbursement topics related to our client's products.
• Serve as payer expert for defined geography and able to communicate changes to key stakeholders in a timely manner.
• Provide office support in accurate coding and billing for the client's products.

Minimum Qualifications & Education:

• Bachelor's degree or a minimum three years of experience in public or private third‑party access arena or pharmaceutical industry in managed care, clinical support, and/or sales or a minimum of 6 years biologic coordinator experience
• Minimum two years' of access and reimbursement, managed care, and/or billing and coding support experience
• Experience working with Buy and Bill products and a thorough understanding of the entire reimbursement process from script to injection required
• Ophthalmic, retina specialists and biosimilar experience preferred
• Experience establishing relationships within a practice by working closely to help remove reimbursement barriers to specialty products for their patients
• Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare Part D (Pharmacy Benefit design and coverage policy) a plus
• Knowledge of Managed Care, Government, and Federal payer sectors, as well as Integrated Delivery Network/Integrated Health Systems a plus
• Ability to travel and cover large multistate geography territories, 50% travel required
• Excellent presentation and project management skills

The annual base salary for this position ranges from $155,000 to $160,000. The base salary range represents the anticipated low and high of the Syneos Health range for this position. Actual salary will vary based on various factors such as the candidate's qualifications, skills, competencies, and proficiency for the role. In addition, some positions may include a company car or car allowance and eligibility to earn commissions/bonus based on company and / or individual performance.

At Syneos Health, we are dedicated to building a diverse, inclusive and authentic workplace. If your past experience doesn't align perfectly, we encourage you to apply anyway. At times, we will consider transferable skills from previous roles. We also encourage you to join our Talent Network to stay connected to additional career opportunities.

Why Syneos Health?

Our ability to collaborate and problem-solve makes a difference in patients' lives daily. By joining one of our field access teams, you will partner with industry experts and be empowered to succeed with the support, resources, and autonomy needed to successfully navigate the complex reimbursement landscape. The diversification and breadth of our new and existing partnerships create a multitude of career paths and employment opportunities. Join our game-changing, global company dedicated to creating better, smarter, faster ways to get biopharmaceutical therapies to patients Experience the thrill of knowing that your everyday efforts are contributing to improving patients' lives around the world.

Work Here Matters Everywhere | How are you inspired to change lives?

Syneos Health companies are affirmative action/equal opportunity employers (Minorities/Females/Veterans/Disabled)

Benefits

• competitive compensation package
• Health benefits to include Medical, Dental and Vision
• Company match 401k
• flexible paid time off (PTO) and sick time

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