Field Reimbursement Specialist

Cencora•Pittsburgh, PA

About The Position

The Field Reimbursement Specialist (FRS) serves as a subject-matter expert on reimbursement, access, and coverage issues. The role supports patient access to specialty medications by educating healthcare providers and their staff about complex insurance and reimbursement processes and helping resolve access barriers. FRSs act as liaisons among providers, manufacturers, pharmacies, and payers, with a focus on pharmacy benefit reimbursement, prior authorizations, appeals, and specialty pharmacies. The position involves meeting with healthcare providers and office staff to provide education about reimbursement and access considerations for a specialty medication, using client-approved resources. The FRS collaborates with the client’s patient assistance and reimbursement support services and uses knowledge of coverage, patient assistance, and health policy to address access challenges. The role requires weekly travel, potentially including overnight stays, to healthcare offices within a designated territory. Candidates must live within a reasonable commuting distance of a major airport in the listed location and be able to travel up to 80% within a territory that may include Ohio; Buffalo and Rochester, New York; Pittsburgh, Pennsylvania; Lexington, Kentucky; and a small portion of West Virginia. Candidates must be willing to obtain a Prior Authorization Certified Specialist (PACS) certification within the first six months of employment.

Requirements

High school diploma or GED.
Experience working in healthcare directly resolving pharmacy benefit access issues.
Experience with extensive travel.
Willingness to obtain a Prior Authorization Certified Specialist (PACS) certification within the first six months of employment.
Ability to conduct field-based reimbursement and access support, education, and consultation for key account customers and cross-functional partners.
Understanding of specialty pharmacy dynamics.
Experience in revenue cycle, formulary, benefit investigations, prior authorization, coding, and appeals processes.
Deep understanding of pharmacy benefits and policies.
Strong time-management and planning skills.
Proficiency in Microsoft Word, PowerPoint, Excel, and Outlook.
Live within a reasonable commuting distance of a major airport in the listed location and be able to travel within the designated territory, including Ohio; Buffalo, New York; Rochester, New York; Pittsburgh, Pennsylvania; Lexington, Kentucky; and a small portion of West Virginia.

Nice To Haves

Bachelor’s degree or relevant practice management experience.
Previous experience as a Field Reimbursement Manager or Specialist.

Responsibilities

Educate providers and their office staff on access and reimbursement topics using client-approved resources.
Support appropriate patient access to the client’s products by resolving reimbursement and coverage challenges.
Collaborate with other patient assistance and reimbursement support services offered by the client.
Educate provider office staff and practice managers about insurance issues relevant to the supported product and communicate important coverage and payer policy changes within assigned territories.
Educate provider office staff about payer coverage management strategies, including coding, billing, formulary, prior authorization, and appeal processes.
Assess office processes and identify root causes of access or reimbursement issues.
Deliver interactive educational presentations at provider sites of service.
Provide information on relevant reimbursement topics related to the client’s products, subject to client approval.
Perform other related duties as assigned.