Field Reimbursement Specialist

Cencora • Harrisburg, PA

1d

About The Position

The Field Reimbursement Specialist (FRS) serves as a subject-matter expert on reimbursement, access, and coverage issues. The role helps patients access 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 explain reimbursement and access considerations for a specialty medication, using client-approved resources. The role involves weekly travel, potentially including overnight stays, to healthcare offices in an assigned territory. Candidates must live within reasonable commuting distance of a major airport in the listed location. The territory may include Ohio; Buffalo and Rochester, New York; Pittsburgh, Pennsylvania; Lexington, Kentucky; and a small portion of West Virginia. Travel may be up to 80%.

The position also involves educating office staff about coverage and payer-policy changes, investigating the causes of access or reimbursement problems, delivering interactive presentations, and collaborating with the client’s patient assistance and reimbursement support services. Candidates must be willing to obtain Prior Authorization Certified Specialist (PACS) certification within their first six months of employment.

Requirements

• High school diploma or GED.
• 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 provide field-based reimbursement and access support, education, and consultation to 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.
• 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 about insurance issues relevant to the supported product and communicate important coverage and payer-policy changes in the assigned territory.
• 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 client 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, professional development resources, and mentorship opportunities.
• Employee resource groups and volunteer activities.

What This Job Offers

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