Specialist, Access and Reimbursement

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.
• 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.

Qualifications

• 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.