Specialist, Access and Reimbursement

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. Proficient in understanding local plans and prior authorization, medical exception, and appeal processes. Take inbound and outbound calls and educate FRMs and HCPs to diminish access barriers for patients. Educate on AbbVie access and reimbursement support tools, advise HCPs on patient program eligibility, and educate HCP offices on payer processes and procedures. Use critical thinking to assess workloads at the account level for seamless communication.

Responsibilities:
- Collaborate with FRMs and HCPs in designated territories to enhance patient access.
- Educate FRMs/HCPs on patient support programs, access/reimbursement tools, and resources.
- Provide local expertise on prior authorization, medical exception, and appeal processes for inbound/outbound calls.
- Develop relationships with providers; facilitate clear information exchanges with stakeholders.
- Lead process improvement initiatives to enhance system efficiencies and patient access strategies.
- Maintain understanding of business procedures, deviations, and case processing as needed.
- Assess and prioritize workloads at the account level.
- Monitor and streamline stakeholder communications to reduce redundancies.
- Meet performance metrics; uphold privacy standards and required training; comply with laws and SPII policies; perform additional tasks as needed.

Qualifications:
- Bachelor’s degree or Associate Degree in health sciences or business preferred (comparable/relevant experience considered).
- 3–5 years healthcare experience with reimbursement/billing, prior authorization, appeals, and specialty pharmacy operations.
- Understanding of regulations/risk for reimbursement support services; technical understanding of coverage, coding, payment, and specialty product distribution rules.
- Knowledge of access/reimbursement support service centers and compliant interactions.
- Thorough understanding of technical payer policy processes, systems, and coverage requirements.
- Strong written/verbal communication; maintain positive service image with challenging issues.

Benefits:
- Paid time off (vacation, holidays, sick), medical/dental/vision insurance, 401(k) (eligible employees).
- Short-term incentive program eligibility.

Application instructions:
- None provided.