Field Reimbursement Specialist

Johnson & Johnson•Guaynabo, PR

3d•Onsite

About The Position

Johnson & Johnson is recruiting a Field Reimbursement Specialist to be based in Puerto Rico, supporting the Patient Engagement and Customer Solutions organization and patients receiving J&J Immunology therapies. The role serves as the primary field-based lead for educating healthcare providers and office staff, assisting with access issues, and resolving barriers to patient treatment. It includes spending up to 50% of time on-site with healthcare providers and collaborating with multiple stakeholders. The position requires frequent territory travel, with travel of up to 75%, and may involve overnight and weekend travel for Puerto Rico- and U.S.-based meetings and conventions. The position is eligible for a company vehicle due to travel requirements. The specialist provides education and practical support related to product coverage, prior authorizations, appeals, reimbursement processes, claims submissions, procedures, and coding. The role also builds relationships with Immunology accounts, supports local field teams as a reimbursement expert, monitors market and payer dynamics, and collaborates across J&J departments. Work must follow applicable ethical, legal, and compliance standards.

Requirements

Bachelor’s degree; healthcare or business preferred.
Minimum of 2–3 years of relevant professional experience.
Account management and/or reimbursement experience in a provider-office setting, including building strong customer relationships.
Demonstrated expertise with pharmacy and medical/buy-and-bill benefits, coding, and billing.
Reimbursement or relevant managed care experience, including revenue cycle, buy-and-bill, prior authorization, coding, and appeals processes.
Ability to establish relationships, collaborate, and influence across a matrix organization.
Problem-solving ability to navigate challenging access scenarios and identify timely, efficient solutions.
Excellent written and verbal communication skills and efficient follow-through.
Experience working with patient support hub services.
Valid Puerto Rico driver’s license and driving record that complies with company standards.
Ability to consistently maintain up to 75% travel.
Flexibility in geographical territory coverage; preference for a home base in the Metro, North, or West area of Puerto Rico.
Bilingual in English and Spanish.
Ability to travel overnight and/or on weekends as required or needed for Puerto Rico- and U.S.-based meetings and conventions.

Nice To Haves

Immunology disease-state experience.
Advanced degree and/or relevant certifications in prior authorization and/or billing and coding.
Market access acumen related to payer approval processes and business acumen.
Understanding of Medicare, Medicaid, and private payer initiatives affecting reimbursement of pharmaceutical and biotechnology products.
Technical knowledge and expertise in payer policy, including coding, coverage, and payment.
Demonstrated competence using Salesforce.com CRM, Microsoft Word, and Excel.

Responsibilities

Educate healthcare providers and office staff on product coverage, prior authorizations and appeals, reimbursement processes, claims submissions, procedures, and payer coding requirements for core and launch products.
Collaborate with sales representatives, key account specialists, and other field support team members, serving as a reimbursement expert for the local team.
Address critical patient access and affordability issues with urgency.
Partner with managed care colleagues to understand current policies and potential future changes.
Provide field-based reimbursement and access support, education, and problem-solving in accordance with FRAS Rules of Engagement.
Build trust-based relationships with customers across assigned Immunology accounts.
Manage territory logistics, routing, and account business planning.
Maintain and expand knowledge of national, regional, local, and account market dynamics, including coverage and coding requirements.
Build knowledge of hub and specialty distribution channels to improve support for practices and patients.
Collaborate with internal J&J departments, including marketing, sales, medical science, SCG, HCC, and PECS.
Provide expertise and insights on access and affordability solutions across payer types and plans relevant to Puerto Rico, including Medicare, Medicaid Managed Care, and commercial plans.
Execute business in accordance with ethical, legal, and compliance standards, including completing required training on time.
Stay current on product coverage, access knowledge, marketplace conditions, and stakeholder practices, and deliver approved materials effectively.
Adapt to changes in the healthcare ecosystem to customize resources and messaging for healthcare providers and staff.