Field Reimbursement Specialist - West (Home-based, Surgical Experience required)
As the only global provider of commercial solutions, Quintiles understands what it takes to deliver nationally and internationally. Our teams help biopharma get their medicines to the people who need them. We help customers gain insight and access to their markets and ultimately demonstrate their product’s value to payers, physicians and patients. A significant part of our business is acting as the biopharma’s sales force to physicians or providing nurses to educate patients or prescribers. With the right experience, you can help deliver medical breakthroughs in the real world.
We are excited to announce that at this time we are looking for Field Reimbursement Specialist to join our team of over 10,000 global field representatives in several regions making over 20 million product details annually for our pharmaceutical and biotech clients.
The Field Reimbursement Specialist (FRS) serves as the local market coverage and access expert to minimize reimbursement barriers for patients and providers and optimize access to products in their assigned areas. The FRS also develops ethical and customer-oriented reimbursement tactics, and proactively communicate payer criteria/terms and practices, as these relate to reimbursement.
The FRS will work closely with internal/external teams, project/product manager and operations leaders to support targeted accounts for customer products under both medical and pharmacy benefit designs and will be a Medicaid and Medicare Part B coverage and policy subject matter expert for their assigned region.
The FRS will work with State and Federal level policy influencers to stay abreast of changes that can impact clients’ products.
This role requires frequent domestic travel up to 80% covering West of Mississippi (Chicago, Dallas, and Denver).
- Reimbursement (coding, coverage any payment policy) expertise on manufacturer products in all places of service (POS) under both medical and pharmacy benefit designs
- Billing and claims systems knowledge for all provider types and places of service (POS)
- Educate and support targeted accounts and HCPs on manufacturers support programs and available patient access services
- Assist key accounts to overcome access barriers for key client stakeholders
- Professionally represent manufacturer’s patient and physician access services
- Collaborate with manufacturer’s internal teams to ensure alignment
- Support a positive impact on the patient journey and the brand experience
- Provide education on the product services to support patient access to therapy
- Develop and execute geographical strategic and tactical plans to meet customer and business needs
- Frequent interactions with key stake holders in multiple sites of care including: physician practices, ambulatory surgical centers, hospital out-patient departments and other related facilities
- Provide information on relevant access topics related to client’s products
- Review patient-specific information in cases where the site has specifically requested the assistance in resolving any issues or coverage challenges
- Provide feedback to internal manufacturer teams on local payer trends and access issues
EEO Minorities/Females/Protected Veterans/Disabled
REQUIRED KNOWLEDGE, SKILLS AND ABILITIES
- The FRS must understand billing and claims systems for provider offices and related facilities, including all places of service (POS). This also include understanding coding, coverage and payment policies and how these elements impact patient access to appropriate medical care.
- The FRS must have clinical understanding of client products sufficient to support any medical necessity position for accurate claims.
- Bachelor’s degree required, Health management degree preferred
- Coding certification a plus
- Nursing degree a plus
- Practice management certification a plus
- Compliance certification a plus
- Coding and billing background required
- Retail, hospital and specialty distribution required
- Hospital, ASC and surgical place of service experience required
- Oral, injectables, medical device and surgical product management
- HUB engagement
- Contract management:
- Provider management,
- Pharmacy Benefit Manager (PBM) Executive Account Manager,
- insurance/payor coding, billing and contracting,
- Biopharma sales/reimbursement
- Advocacy and local, state or federal reimbursement policy experience a plus.
- Coverage policy
- Payment policy
- Strong computer literacy (Word, Excel, Power Point, web meeting)
- Problem solving and decision making skills
- Demonstrated strong interpersonal and self-presentation skills
- Flexibility regarding working hours and geographical coverage
- Extensive use of telephone and face-to-face communication requiring accurate perception of speech
- Frequent domestic travel
- Full driving license
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