Field Reimbursement Specialist

Cencora • USA > FL > Remote, FL

4d

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 insurance and reimbursement processes and resolving access barriers. The FRS acts as a liaison among providers, manufacturers, pharmacies, and payers, with particular expertise in pharmacy benefit reimbursement, prior authorizations, appeals, and specialty pharmacies.

The FRS provides client-approved education to healthcare providers and office staff on reimbursement and access considerations for specialty medications, supports appropriate patient access by resolving coverage challenges, and collaborates with other client patient-assistance and reimbursement-support services. The role involves weekly travel, potentially including overnight stays, to healthcare offices within 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% in a territory that includes, but may not be limited to, Florida.

The position requires a high school diploma or GED. A bachelor's degree or relevant practice-management experience is preferred. 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 working in healthcare directly resolving pharmacy-benefit access issues.
• Experience with extensive travel.
• Expertise in pharmacy-benefit reimbursement, prior authorizations, appeals, and specialty pharmacies.
• Experience with revenue cycle, formulary, benefit investigations, 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.
• Ability to live within a reasonable commuting distance of a major airport in the listed location and travel within an assigned territory that includes, but may not be limited to, Florida.
• 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 client product and communicate important coverage and payer-policy changes within assigned territories.
• Explain payers’ coverage-management strategies for the product, 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 information on relevant reimbursement topics related to client products, subject to client approval.
• Support appropriate patient access to client products by resolving reimbursement and coverage challenges.
• Collaborate with other patient-assistance and reimbursement-support services offered by the client.
• Conduct field-based reimbursement and access support, education, and consultation for key account customers and cross-functional partners.
• Perform other related duties as assigned.

Benefits

• Medical, dental, and vision care.
• Benefits supporting physical, emotional, financial, and social wellness.
• 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