Field Reimbursement Specialist

Cencora • Pittsburgh, PA

14h

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 resolving access barriers. FRSs act as liaisons among providers, manufacturers, pharmacies, and payers, with particular expertise in pharmacy benefit reimbursement, prior authorizations, appeals, and specialty pharmacies.

The FRS meets directly with healthcare providers and office staff to provide client-approved education about reimbursement and access considerations for a specialty medication. The role involves field-based education and consultation, collaboration with other patient assistance and reimbursement support services, and weekly travel—including possible overnight stays—to healthcare offices in an assigned 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 in healthcare directly resolving pharmacy benefit access issues.
• Experience with extensive travel.
• 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 a reasonable commuting distance of a major airport in the listed location and be able to travel within the assigned territory, potentially including Ohio; Buffalo and Rochester, NY; Pittsburgh, PA; Lexington, KY; and a small portion of West Virginia.
• Willingness to obtain a Prior Authorization Certified Specialist (PACS) certification within the first six months of employment.

Nice To Haves

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

Responsibilities

• Educate provider office staff and practice managers about insurance issues relevant to the supported product and communicate important coverage and payer policy changes in the assigned territory.
• Explain payer coverage-management strategies, including coding, billing, formulary, prior authorization, and appeals 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 reimbursement topics related to the client’s products.
• 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.
• 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, professional development resources, and mentorship opportunities.
• Employee resource groups and volunteer activities.

What This Job Offers

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