Field Reimbursement Manager

Upsher-Smith Laboratories

1d•Remote

About The Position

The Field Reimbursement Manager (FRM) ensures patients and providers can successfully access the company’s therapies by delivering expert reimbursement and access support. This role educates healthcare providers and office staff on coverage, coding, prior authorization, appeals, and pharmacy and payer requirements, while identifying and resolving reimbursement barriers across assigned accounts. Working closely with Market Access, Sales, Patient Services, and specialty pharmacy/hub partners, the FRM supports pull-through of access strategies and provides timely guidance on public and private payer policies. The FRM serves as the primary subject-matter expert for reimbursement processes and collaborates cross-functionally to deliver a compliant, seamless customer experience that enables appropriate patient access to therapy. Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions. The above statements are intended to describe the nature of work performed by those in this job and are not an exhaustive list of all duties. Nothing in this job description restricts managements right to assign or reassign duties and responsibilities to this job at any time which reflects management’s assignment of essential functions.

Requirements

Bachelor’s degree in business, life sciences, healthcare, or a related field.
Minimum of 8 years of experience in pharmaceutical or biotech roles involving field reimbursement, patient access, specialty pharmacy, payer interactions, or managed care.
Strong knowledge of medical and pharmacy benefits, coding (ICD-10, CPT, HCPCS), billing practices, and reimbursement processes.
Deep understanding of commercial, Medicare, and Medicaid insurance landscapes.
Demonstrated ability to analyze access trends, solve complex reimbursement issues, and present clear, simplified solutions.
Excellent communication, presentation, and collaboration skills with the ability to influence without authority.
Strong prioritization, decision-making, and independent working skills, with the ability to operate effectively in cross-functional teams.
Although this is a virtual role, candidates should be able to travel as needed to cover large, multi-state territories; approximately 15–20% travel may be required depending on geography.

Nice To Haves

Experience supporting specialty or rare-disease therapies, biologics, or CNS products.
Prior experience in field reimbursement, hub services, specialty pharmacy networks, or payer operations.
Familiarity with EMR systems and prior authorization platforms.
PACS certification is a plus

Responsibilities

Reimbursement & Access Support Educate HCP offices on access protocols, payer requirements, benefit verification, prior authorization, appeals, coding/billing, and required safety or compliance processes for our portfolio of rare disease products.
Provide real-time support to resolve reimbursement, access, and specialty-pharmacy issues for both accounts and patients.
Deliver payer policy updates, interpret coverage decisions, and identify access barriers or emerging trends.
Facilitate appropriate use of patient support programs, hub services, copay assistance, and financial aid resources.
Maintain expert knowledge of payer policies, reimbursement processes, and patient support options.
Account Management & Field Operations Build and maintain strong relationships with Centers of Excellence, including pediatric neurology and epilepsy treatment centers within children's hospitals, by engaging HCPs and office staff involved in treatment decisions and overall patient care.
Maintain strong working relationships with USL-contracted specialty pharmacies and ensure aligned engagement related to the resolution of patient -level reimbursement challenges.
Support new account onboarding and training in access workflows for our portfolio of rare disease products.
Monitor reimbursement trends and communicate field insights through business reviews and internal updates.
Ensure timely follow-up and action planning to address account and patient needs.
Cross-Functional Collaboration Collaborates with Market Access, Sales, Patient Services, Medical Affairs, marketing & external specialty-pharmacy teams to ensure aligned and compliant support.
Provide field insights to guide payer strategy, patient services enhancements, and operational improvements.
Contribute to reimbursement training materials, tools, and best practices.
Educate and train stakeholders on coverage status, PA process, appeals and patient services.
Build and maintain relationships with HCPs, office staff and health system stakeholders so that the individual is viewed as a trusted partner in support of appropriate patient therapy.
Represent the organization at industry events and with patient advocacy groups.
Compliance & Documentation Ensure all interactions follow legal, regulatory, and company compliance requirements.
Maintain accurate documentation of field activities and customer interactions.