Specialist, Access and Reimbursement

AbbVie; Illinois; On-site; USD 65,000 - 100,000; Full time

Job summary

AbbVie in Illinois is seeking a skilled access specialist to partner with Field Reimbursement Managers and HCPs to optimize patient outcomes by navigating prior authorization, medical exceptions, and appeals. You will educate on reimbursement processes and patient support tools and build strong provider relationships.

The role emphasizes clear communication, process improvement, and adherence to privacy and regulatory standards across multiple brands and channels.

Qualifications

• 3–5 years of experience in healthcare with knowledge in reimbursement, billing, prior authorization, appeals, and specialty pharmacy operations.
• Professional written and verbal communication skills to interact with all levels of the organization.
• Understanding of rules, regulations and risks of reimbursement support services.

Responsibilities

• Collaborate with FRMs and HCPs in designated territories to enhance patient access and support outcomes.
• Educate on patient support programs, tools, and services for access and reimbursement.
• Explain plans and educate on prior authorization, medical exception, and appeal processes.
• Develop and maintain relationships with providers in the territory to facilitate information exchange.
• Identify and implement process improvements to enhance system efficiencies and patient access.

Skills

Communication skills

Healthcare experience

Compliance & privacy knowledge

Education

Bachelor's or Associate Degree

Job description

About AbbVie

AbbVie's mission is to discover and deliver innovative medicines and solutions that solve serious health issues today and address the medical challenges of tomorrow. We strive to have a remarkable impact on people's lives across several key therapeutic areas including immunology, oncology and neuroscience - and products and services in our Allergan Aesthetics portfolio. For more information about AbbVie, please visit us at www.abbvie.com. Follow @abbvie on LinkedIn, Facebook, Instagram, X and YouTube.

Purpose

Serve as a skilled specialist in advanced access knowledge and skills, partnering closely with Field Reimbursement Managers (FRMs) and Health Care Providers (HCPs) within assigned territories to optimize patient outcomes. The individual will be highly proficient in understanding local plans and all facets of prior authorization, medical exception, and appeal processes. Exceptional communication skills are crucial, as the role requires taking inbound and outbound calls, clearly educating both FRMs and HCPs to effectively diminish access barriers for patients. Responsible to educate on the access and reimbursement support tools available at AbbVie, advising HCPs on patient program eligibility, and educating HCP offices on payer processes and procedures. With strong critical thinking abilities, the individual will adeptly assess workloads at the account level, ensuring seamless communication and efficient interactions.

Responsibilities

• Collaborate with Field Reimbursement Managers (FRMs) and Health Care Providers (HCPs) in designated territories to enhance patient access and support positive health outcomes.
• Educate FRMs and HCPs on patient support programs, including tools and services for access and reimbursement. Inform them about resources available to resolve patient access challenges.
• Provide local expertise on plans and efficiently educate on all aspects of prior authorization, medical exception, and appeal processes within assigned region for all inbound and outbound calls.
• Develop and sustain relationships with relevant providers within the territory. Utilize strong communication skills to facilitate clear, concise, and efficient information exchanges with FRMs, HCPs, and other stakeholders.
• Take ownership of process improvement initiatives, continuously seeking ways to enhance system efficiencies and patient access strategies.
• Maintain an understanding of current business procedures, deviations, and case processing for all brands and channel sources, as needed.
• Utilize critical thinking to assess and prioritize workloads at the account level, ensuring optimal resource allocation and seamless operations.
• Monitor and streamline communication and interactions between stakeholders to promote efficiency and reduce redundancies.
• Meet or exceed department standards relative to performance metrics. Maintain a work environment that upholds privacy standards required by law and AbbVie policy. Understand and comply with all required training, including adherence to federal, state, and local laws, SPII policies and guidelines, and the policies and procedures of Complete Patient Access and AbbVie. Perform additional tasks, activities, and projects as deemed necessary by management.

• Bachelor’s degree or Associate Degree in health sciences or business preferred. Comparable or relevant experience will be considered.
• 3-5 years of experience in the healthcare industry with knowledge in reimbursement, billing, prior authorization, appeals, and specialty pharmacy operations.
• Demonstrated understanding of the rules, regulations and risks associated with provision of reimbursement support services. Demonstrated deep technical understanding of coverage, coding, payment and distribution of specialty products and the rules and regulations that govern provision of reimbursement support.
• Strong understanding of access and reimbursement support service centers and how to effectively interact in a compliant fashion.
• Thorough understanding of the technical payer policy processes, systems and requirements for coverage.
• Must have professional written and verbal communication skills to interact with and build and maintain relationships with all levels of the organization. Must maintain a positive service image at all times even when dealing with challenging issues and unsatisfied customers.

Applicable only to applicants applying to a position in any location with pay disclosure requirements under state orlocal law:

• The compensation range described below is the range of possible base pay compensation that the Companybelieves ingood faith it will pay for this role at thetimeofthis posting based on the job grade for this position.Individualcompensation paid within this range will depend on many factors including geographiclocation,andwemayultimatelypaymore or less than the posted range. This range may bemodifiedin thefuture.
• We offer a comprehensive package of benefits including paid time off (vacation, holidays, sick),medical/dental/visioninsurance and 401(k) to eligibleemployees.
• This job is eligible toparticipatein our short-term incentiveprograms.

Note: No amount of payis considered to bewages or compensation until such amount is earned, vested, anddeterminable.Theamountandavailabilityof anybonus,commission, incentive, benefits, or any other form ofcompensation and benefitsthat are allocable to a particular employeeremainsin the Company'ssoleandabsolutediscretion unless and until paid andmay bemodifiedat the Company’s sole and absolute discretion, consistent withapplicable law.

AbbVie is an equal opportunity employer and is committed to operating with integrity, driving innovation, transforming lives and serving our community. Equal Opportunity Employer/Veterans/Disabled.

US & Puerto Rico only - to learn more, visit https://www.abbvie.com/join-us/equal-employment-opportunity-employer.html

US & Puerto Rico applicants seeking a reasonable accommodation, click here to learn more:

https://www.abbvie.com/join-us/reasonable-accommodations.html