Perspectum Diagnostics

The Field Reimbursement Specialist is a critical field-based role responsible for providing expert guidance and support to healthcare providers and their staff on all aspects of Perspectum’s commercial products, billing & reimbursement, coverage, and patient access. This role is a key partner to the operations and customer success team, working collaboratively to ensure successful product adoption and patient care by proactively addressing and resolving coverage and reimbursement challenges.

The ideal candidate will possess experience in devices with a deep understanding of the complex payer landscape, including Medicare, Medicaid, and private commercial insurance policies, as well as a strong grasp of healthcare billing and coding processes. They must be an excellent communicator, a problem-solver, and a strategic thinker.

• Payer and Reimbursement Expertise: Serve as the primary expert on all reimbursement and access-related topics for the assigned territory. Stay up to date on changes in payer policies, medical device benefit structures, prior authorization requirements, and government regulations.
• Provider Support and Education: Educate and train healthcare providers, office staff, and billing departments on the reimbursement process for our products. This includes providing guidance on appropriate coding (HCPCS, CPT, ICD-10), documentation requirements, prior authorization procedures, and appeals processes.
• Case Management & Troubleshooting: Work directly with provider offices to resolve complex reimbursement and access issues. This may involve helping to navigate denied claims, and coordinating with PRIA, our company's internal reimbursement support services team.
• Strategic Collaboration with Operations and Customer Success Team: Partner with the operations and customer success team to identify and address reimbursement barriers that may impact product uptake. Provide strategic support during customer meetings to answer reimbursement questions and build confidence in the product's financial viability for the practice.
• Data and Analytics: Track and analyze reimbursement trends within the territory. Provide regular reports to your direct manager on key reimbursement challenges, successes, and insights from the field to inform corporate strategy.
• Patient Support Coordination: Assist provider offices in enrolling patients in our Perspectum Coverage Support program, where we offer Pre/Post claim support.
• Compliance: Ensure all activities are conducted in full compliance with Perspectum’s policies, legal requirements, and ethical standards, including HIPAA and other relevant regulations.
• Content creation:Guide and direct the creation of customer and patient facing Market Access materials such as Billing & Coding guidance, How to Order, Letters of Medical Necessity etc. as aligned with the industry standard.

Qualifications:

• Education:Bachelor's degree or equivalent 5+ years revenue cycle experience.
• Experience:Minimum of [3-5] years of experience in healthcare reimbursement, market access, or a related field. Direct experience as a Field Reimbursement Specialist, Reimbursement Manager, or Billing and Coding Specialist is highly preferred.
• Industry Knowledge:Demonstrated knowledge of the US healthcare landscape, including provider-payerrelationships, reimbursement methodologies, and the appeal and denial process;Proficiency in medical coding (HCPCS, CPT, ICD-10) and billing procedures;Familiarity with buy-and-bill and specialty pharmacy distribution models.
• Skills:
  • Exceptional communication, presentation, and interpersonal skills.
  • Strong analytical and problem-solving abilities.
  • Ability to work independently and manage a large territory.
  • Ability driving multiple initiatives at a rapid pace, making thoughtful recommendations with available data
  • Excellent organizational skills and attention to detail.
  • Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint) and CRM software (e.g., Salesforce).
• Travel:Ability to travel extensively, 50-75% within the assigned territory, including overnight travel, as needed. Must live within 45 minutes of a major airport (no relocation assistance available).This is a field-based position requiring travel by car and plane. The role involves working from a home office and visiting healthcare facilities, which may require standing and walking for extended periods.