Field Reimbursement Specialist
About The Position
The Field Reimbursement Specialist (FRS) serves as a subject-matter expert on reimbursement, access, and coverage issues, helping patients access specialty medications by educating healthcare providers and their staff about insurance and reimbursement processes and resolving access barriers. The FRS acts as a liaison among providers, manufacturers, pharmacies, and payers, with particular emphasis on pharmacy-benefit reimbursement, prior authorizations, appeals, and specialty pharmacies. The role provides education to healthcare providers and office staff using client-approved resources, supports appropriate patient access to client products by addressing reimbursement and coverage challenges, and collaborates with other client patient-assistance and reimbursement-support services. The position requires weekly travel, including possible overnight stays, to healthcare offices in a territory that may include Southern California, Arizona, Utah, Colorado, the Las Vegas metro area, and New Mexico. Candidates must live within reasonable commuting distance of a major airport in the listed location and be able to travel up to 80%. A typical day includes educating provider staff and practice managers about relevant insurance issues and payer policy changes; explaining coverage-management strategies, coding, billing, formularies, prior authorizations, and appeals; assessing office processes to identify root causes of access or reimbursement issues; delivering interactive educational presentations at provider sites; and providing client-approved information on relevant reimbursement topics. Other related duties may be assigned.
Requirements
- High school diploma or GED required.
- Previous experience working in healthcare directly resolving pharmacy-benefit access issues.
- Experience with extensive travel.
- Willingness to obtain 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, formularies, benefit investigations, prior authorizations, 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, which may include Southern California, Arizona, Utah, Colorado, Las Vegas metro, and New Mexico.
Nice To Haves
- Bachelor’s degree or relevant practice-management experience.
- Previous experience as a Field Reimbursement Manager or Specialist.
Responsibilities
- Educate healthcare 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 about insurance issues relevant to the supported product and communicate important coverage and payer-policy changes in assigned territories.
- Explain payers’ 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 client-approved information on relevant reimbursement topics.
- Travel weekly to healthcare offices within the assigned territory, with potential overnight stays.
- Perform other related duties as assigned.
Benefits
- Medical, dental, and vision care.
- Backup dependent care may be available.
- Adoption assistance.
- Infertility coverage and family-building support.
- Behavioral health solutions.
- Paid parental leave.
- Paid caregiver leave.
- Training programs and professional-development resources.
- Mentorship programs.
- Employee resource groups.
- Volunteer activities.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Education Level
High school or GED
