Access and Reimbursement Counselor

Lake County, IL, US
Dec 06, 2018
Required Education
Bachelors Degree
Position Type
Full time
The Access Reimbursement Counselor (ARC) will be responsible for serving as a dedicated point of contact for healthcare providers/patients for their reimbursement and access needs in his/her geographic zone. The ARC will help patients and healthcare providers navigate through reimbursement issues and administer patient support services for new product launches. This position reports to the New Product Access and Reimbursement Manager.

Key Responsibilities Include:
  • Liaise between healthcare providers, insurance companies, AbbVie Patient Access Support field representatives, Ambassadors, filling pharmacies and patients to administer the Patient Support Service programs per AbbVie policy
  • Accurately assess each assistance request to determine next steps and comprehensive action plan to resolve or prevent the market access or reimbursement challenge
  • Work independently to manage a caseload comprised of healthcare providers, Patient Access Support field representatives, and patients under various levels of urgency dependent upon patient need
  • Provide education to healthcare providers, AbbVie Patient Access Support field representatives, filling pharmacies on reimbursement processes specific to their patient's insurance plan
  • Ability to hold effective, critical conversations with insurance representatives, healthcare providers, patients, and caregivers
  • Maintain accurate records of actions and conversations in the system; follow up on all outstanding actions in the appropriate timeline to drive effective outcomes
  • Collaborate cross-functionally and with peers to support and continue to develop patient support programs, healthcare providers and patients
  • Execute training curriculum for upcoming new product and patient support service launches. Assist in creating or updating documentation for new and existing programs
  • Partner with Field Reimbursement Teams to provide seamless support to healthcare providers while gathering and sharing pertinent trends in insurance reimbursement and plan structure
  • Research, compile, and maintain education materials with insurance benefit information such as but not limited to: appeals and denials processes, payor summary plan descriptions, medical policies, formulary listings, fee schedules, etc. Other duties as assigned

  • Bachelor's Degree or comparable experience in Healthcare Finance, Revenue Cycle, Insurance Claims Processing and/or Specialty Pharmacy Operations
  • Minimum 2 years Reimbursement/Access patient support experience specific to specialty medications or complex procedures; 3-5 years' experience supporting prescribers and patients in a hospital facility or large scale medical office specializing in oncology preferred
  • Understanding of CMS billing practices and Medicare guidelines helpful
  • Demonstrate thorough knowledge of insurance reimbursement and access best practices across multiple Patient Access Support options (hospital charity programs, manufacturer patient assistance programs, co-pay card programs, patient advocacy groups etc.)
  • Demonstrate strong problem solving skills related to complex patient access challenges
  • Experience working with providers to resolve or prevent account issues related to proper coding, billing, denials, and claims appeals related to product coverage and reimbursement
  • Experience educating and mentoring peers and hospital staff in reimbursement processes including payer requirements for Prior Authorization, Pre-Determination, Appeals, and Claims submission guidelines and HIPAA guidelines
  • Ability to work cross-functionally to quickly and effectively reach patient and provider-centric resolutions to improve customer experience
  • Excellent computer skills, including experience with Microsoft Office products(Outlook, Excel, Word, Visio, and Power Point)
  • Strong written and verbal communications and presentation skills. Strong analytical skills and business acumen

Equal Opportunity Employer Minorities/Women/Veterans/Disabled