Reimbursement Specialist ARM Consulting Washington DC
Overview
The Reimbursement Specialist leads patient access initiatives within a manufacturer-sponsored Patient Support Services program. This role drives timely therapy availability by navigating complex reimbursement processes. Candidates excel at resolving access barriers while ensuring full compliance with program guidelines.
What You'll Do16
- 1Conduct detailed medical and pharmacy benefit investigations for assigned products and therapeutic areas
- 2Analyze patient insurance coverage including commercial insurance Medicare Part B Medicare Part D Medicaid Managed Medicaid Employer-sponsored plans Government-sponsored plans
- 3Determine benefit coverage requirements such as deductibles and prior authorization needs
- 4Support prior authorization processes and educate provider offices on documentation expectations
- 5Review payer denial information and identify appropriate next steps
- 6Assist providers with appeal documentation requirements and track submissions
- 7Coordinate reimbursement activities with specialty pharmacy partners
- 8Resolve reimbursement delays impacting therapy initiation
- 9Coordinate collection of supporting information for specialties
- 10Communicate coverage outcomes and access requirements
- 11Escalate recurring barriers to HUB leadership
- 12Support patient assistance programs and affordability initiatives
- 13Manage transitions between specialty pharmacies
- 14Educate patients and providers about manufacturer-sponsored support programs
- 15Ensure accurate enrollment activities comply with all regulations
- 16Case management and documentation tasks
Requirements7
- 1Bachelor's degree in healthcare administration nursing pharmacy life sciences business public health or related field
- 2Five years progressive experience in pharmaceutical HUB services specialty pharmacy patient access services healthcare reimbursement
- 3Experience with commercial payers Medicare Medicaid specialty pharmacies prior authorization platforms
- 4Knowledge of healthcare reimbursement processes appeals procedures payer policies PBM operations
- 5Understanding of specialty medication access pathways copay assistance programs patient assistance programs
- 6Proficiency with HUB case management platforms CRM systems specialty pharmacy portals electronic prior authorization systems payer portals Microsoft Office Suite reporting dashboards
- 7Work authorization not requiring future visa sponsorship
Salary Insight
Salary not disclosed in listing
Location
Required Skills
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