Field Reimbursement Specialist

Mwiah; Springfield, Northern (TN, KY); Hybrid; USD 70,000 - 100,000; Full time

Job summary

Mwiah is seeking a Field Reimbursement Specialist to educate providers on insurance, reimbursement, and coverage issues, and to help patients access specialty medications.

The role involves weekly travel to healthcare offices within a broad territory, addressing prior authorizations, coding, and appeals, and collaborating with payer and patient-assistance teams to resolve access barriers.

Qualifications

• High School Diploma or GED required.
• Bachelor's degree or relevant practice management experience preferred.
• Previous experience as Field Reimbursement Manager/Specialist preferred.
• Willing to obtain PACS certification within six months.

Responsibilities

• Educate provider office staff on insurance issues and payer policy changes within assigned territories.
• Help ensure patient access by resolving reimbursement and coverage challenges.
• Collaborate with reimbursement support services and cross-functional teams.
• Deliver interactive educational presentations at provider sites of service.
• Weekly travel to healthcare offices within the territory, including potential overnight stays.

Skills

Field reimbursement

Specialty pharmacy

Revenue cycle

Prior authorization

Coding & appeals

Payer policies

Time management

Microsoft Word

PowerPoint

Excel

Outlook

Travel readiness

Education

High School Diploma/GED

Bachelor's degree or related practice management experience

Tools

Microsoft Word

PowerPoint

Excel

Outlook

Job description

# **Job Details****Please note:**Interested candidates must live within a reasonable commuting distance of a major airport in the listed location and be able to travel up to 80% within a territory that includes but may not be limited to **Nashville, TN, Knoxville, TN, Springfield, MO, North AL, South IL, and Kentucky.** The Field Reimbursement Specialist (FRS) to serves as a subject-matter expert on reimbursement, access, and coverage issues. The FRS play a critical role in ensuring patients can access specialty medications by educating healthcare providers and their staff on complex insurance and reimbursement processes and resolving access barriers. In this role, FRSs act as liaisons between providers, manufacturers, pharmacies, and payers to navigate reimbursement challenges. They meet directly with healthcare providers and their office staff to provide education on the reimbursement and access considerations specific to a specialty medication. For this position, expertise in pharmacy benefit reimbursement, prior authorizations, appeals, and specialty pharmacies is essential, as the supported medication is typically covered under pharmacy benefits. Key responsibilities include:* Educating providers and their office staff on access and reimbursement topics using client-approved resources.* Supporting appropriate patient access to the client’s products by resolving reimbursement and coverage challenges.* Collaborating with other patient assistance and reimbursement support services offered by the client. This role requires weekly travel, including potential overnight stays, to healthcare offices within a designated territory. FRSs use their expertise in coverage, patient assistance, and health policy to educate office staff, address access challenges, and ultimately help patients receive the medications they need. **As an FRS, a typical day might include:*** Educate provider office staff and practice managers on insurance issues relevant to the supported clients product, and inform the staff of 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.* Probe to understand office processes and ability to discern root causes of access or reimbursement issues.* 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.* Performs other related duties as assigned. #LI-MP1**Skills and Abilities:*** Ability to conduct field-based reimbursement and access support, education, and consultation to key account customers and cross-functional partners.* Understands the dynamics of specialty pharmacy.* 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.* **Live within a reasonable commuting distance of a major airport in the listed location and be able to travel within a territory that includes but may not be limited to Nashville, TN, Knoxville, TN, Springfield, MO, North AL, South IL, and Kentucky.****Education and Experience:*** High School Diploma/GED required.* Bachelor's degree or relevant practice management experience preferred.* Previous experience as Field Reimbursement Manager/Specialist preferred.* Previous experience working in healthcare directly resolving pharmacy benefit access issues.* Experience with extensive travel.* Candidates must be willing to obtain a Prior Authorization Certified Specialist (PACS) certification within the first six months of employment.