Field Reimbursement Specialist (Island Wide)

Purpose

The Field Reimbursement Specialist (FRS is a pivotal field-based asset dedicated to supporting patient access to AbbVie products through direct collaboration with Health Care Providers (HCPs) and their Staff. This role focuses on addressing access and reimbursement-related challenges to ensure an exceptional customer experience embodying AbbVies commitment to patient-centered care. As the principal access liaison for HCP offices throughout Puerto Rico the FRS provides case-specific support to effectively navigate the complexities of the local healthcare landscape and overcome access barriers. This involves educating HCPs on various critical aspects including formulary status drug coverage criteria prescription statuses prior authorization processes essential coding and reimbursement requirements and support programs eligibility. Adopting a comprehensive case management approach the FRS systematically identifies and addresses treatment initiation obstacles.

Responsibilities

• Lead initiatives to educate Health Care Providers (HCPs) and their staff on AbbVies comprehensive patient support programs focusing on access and reimbursement resources
• Deliver strategic education on product-specific acquisition channels enhancing understanding of Specialty Pharmacy networks specialty distribution and Commercial Medicare and Medicaid access options.
• Develop tailored access solutions to educate and support HCP accounts by recognizing specific access barriers prescription gaps and documentation challenges to anticipate and/or optimize prior authorization requirements coverage determination processes and health insurance escalation procedures.
• Serve as subject matter expert on payer policy formulary status and coverage criteria to educate HCP on current and evolving reimbursement requirements including coding treatment considerations appropriate claims submission process and best practice.
• Liaise with AbbVies Access and Reimbursement support center (Hub) to ensure timely communication prescription status updates and support program eligibility to providers offices.
• Develop and execute proactive account engagement plans to advance the customer experience.
• Collaborate with Patient Services and Commercial account management teams to ensure an effective and compliant access experience.
• Build and maintain trusted relationships with appropriate accounts and providers across the assigned territory stand-in as a consistent point of contact for access-related needs Track and analyze changes in payer policies healthcare legislation and managed care trends and translate this knowledge into actionable insights for field excellence.

Significant Work Activities: 

• Driving a personal auto or company car or truck or a powered piece of material handling equipment

Qualifications :

Qualifications

• Bachelors degree or higher in science business public health pharmacy or relevant and equivalent industry experience required.
• Minimum 5 years in the pharmaceutical or biotechnology industry with at least 3 years in Managed Health Care Payer Account Management or Access and Reimbursement is required. Prior account management or case management experience is a plus.
• Fluent in English and Spanish with excellent written verbal and presentation skills.
• Valid drivers license and ability to travel throughout the assigned territory.
• Comprehensive understanding of Commercial Medicare Advantage/Platino and Medicaids dynamics.
• Deep understanding of local and federal healthcare landscape including coverage coding and payment for specialty medicines under both medical and pharmacy benefits.
• Proven knowledge of rules regulations and compliance risks associated with reimbursement support services.
• Ability to effectively communicate technical coding and billing requirements across various care settings.
• Comprehensive understanding of Parts A B C and D or Medicare and associated reimbursement dynamics.
• Expertise in drug acquisition dispensing pathways and distribution models including Specialty Pharmacies white-bagging and brown-bagging concepts.
• Strong territory and account management skills including planning prioritizations resource optimization and the ability to educate and influence HCPs for access-related resolutions. Strong territory and account management skills including.

Key Stakeholders 

all local USA and global relevant functions in matrix. External: Healthcare Providers Office Staff Service Providers for Patient Support Programs and Third-Party Vendors

Additional Information :

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

• The compensation range described below is the range of possible base pay compensation that the Company believes in good faith it will pay for this role at the time ofthis posting based on the job grade for this position. Individual compensation paid within this range will depend on many factors including geographic locationand we may ultimately pay more or less than the posted range. This range may be modified in the future. 

• We offer a comprehensive package of benefits including paid time off (vacation holidays sick) medical/dental/vision insurance and 401(k) to eligible employees.

• This job is eligible to participate in our short-term incentive programs. 

Note: No amount of pay is considered to be wages or compensation until such amount is earned vested and determinable. The amount and availability of anybonus commission incentive benefits or any other form of compensation and benefits that are allocable to a particular employee remains in the Companys soleand absolute discretion unless and until paid and may be modified at the Companys sole and absolute discretion consistent with applicable 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  & Puerto Rico applicants seeking a reasonable accommodation click here to learn more:

Work :

No

Employment Type :

Full-time