Field Reimbursement Specialist

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 AbbVie's 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 AbbVie's 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 AbbVie's 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 • Bachelor’s degree or higher in science, business, public health, pharmacy, or relevant required. • Minimum 5 years in the pharmaceutical or biotechnology industry, with at least 3 years in Managed Health Care, Payer Account Management, Specialty Pharmacy, or Access and Reimbursement. Prior account management or case management experience is a plus. • Deep understanding of local and federal healthcare landscape, including coverage, coding, and payment for specialty medicines under both medical and pharmacy benefits. • Comprehensive understanding of Commercial, Medicare Advantage/Platino, and Medicaids dynamics. • 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 reimbursem