Field Reimbursement Specialist
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 insurance and reimbursement processes and helping resolve access barriers. FRSs act as liaisons among providers, manufacturers, pharmacies, and payers, offering 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 involves weekly travel, including possible overnight stays, to healthcare offices within an assigned territory. Candidates must live within reasonable commuting distance of a major airport in the listed location and be able to travel up to 80%. The territory includes, but may not be limited to, Virginia, Washington, D.C., Kentucky, and Tennessee.
Requirements
- High school diploma or GED.
- Previous 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.
- Residence within reasonable commuting distance of a major airport in the listed location and ability 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 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 on insurance issues relevant to the supported client product, including important coverage and payer policy changes within assigned territories.
- Explain payers’ coverage management strategies for the product, 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, as approved by the client.
- Perform other related duties as assigned.
Benefits
- Medical, dental, and vision care.
- Backup dependent care.
- 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 and volunteer activities.
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What This Job Offers
Job Type
Full-time
Education Level
High school or GED
