Field Reimbursement Specialist

Cencora • San Diego, CA

4d • $94,500 - $148,060

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 on complex insurance and reimbursement processes and by helping resolve access barriers. The FRS acts as a liaison among providers, manufacturers, pharmacies, and payers, providing education specific to a specialty medication. Expertise in pharmacy benefit reimbursement, prior authorizations, appeals, and specialty pharmacies is essential because the supported medication is typically covered under pharmacy benefits.

The position requires weekly travel, including potential overnight stays, to healthcare offices in a designated territory. Candidates must live within 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 Southern California, Arizona, Utah, Colorado, the Las Vegas metro area, and New Mexico. The FRS uses knowledge of coverage, patient assistance, and health policy to educate office staff, address access challenges, and help patients receive needed medications.

Requirements

• High school diploma or GED.
• Previous experience working in healthcare and 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 with 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 reasonable commuting distance of a major airport in the listed location and be able to travel within the assigned territory.

Nice To Haves

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

Responsibilities

• Educate providers and 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 on insurance issues relevant to the supported product and communicate important coverage and payer policy changes within assigned territories.
• Explain payer coverage management strategies for the product, including coding, billing, formulary, prior authorization, and appeals processes.
• Understand office processes and identify root causes of access or reimbursement issues.
• Deliver interactive educational presentations at various provider sites of service.
• Provide information on relevant reimbursement topics related to the client’s products, based on client approval.
• Perform other related duties as assigned.

Benefits

• Medical, dental, and vision care.
• Support for working families, which may include backup dependent care, adoption assistance, infertility coverage, family building support, behavioral health solutions, paid parental leave, and paid caregiver leave.
• Training programs and professional development resources.
• Mentorship programs.
• Employee resource groups.
• Volunteer activities.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED