Field Reimbursement & Access Lead - Retina

Outlook Therapeutics, Inc.; Ohio; Remote; USD 125,000 - 170,000; Full time

Benefits offered by this job

Competitive base salary and equity

Comprehensive health coverage

401(k) with company match

Generous paid time off and holidays

Direct access to leadership and growth

Job summary

Outlook Therapeutics is seeking a Field Reimbursement & Access expert for a U.S. field-based role (OH, IN territory). You will be the reimbursement resource for retina practices, educate on payer policies, and guide prior authorization and appeals to support a US product launch.

You will own a defined territory, lead quarterly reviews, analyze denial trends, and collaborate with Sales to ensure consistent messaging. Travel 50–75% is required.

Qualifications

• 5-10 years of combined experience in reimbursement, market access, patient services, or a related field within pharmaceuticals, biotech, or specialty healthcare.
• Hands-on experience navigating Medicare (including MACs), Medicare Advantage, Medicaid, and commercial payer coverage.
• Practical experience with benefit verification, prior authorization, claims support, and the appeals process.
• Track record of using claims data to identify denial trends and coding-related barriers.
• Strong verbal and written communication skills, with the ability to build trust with office staff without engaging in promotional discussion.

Responsibilities

• Serve as the primary field reimbursement resource for practice administrators, billing/coding staff, and clinical teams supporting our retina portfolio.
• Educate office staff on payer coverage policy, medical-benefit billing and coding (HCPCS/CPT/J-codes, ICD-10, modifiers), prior-authorization requirements, and clean-claim submission.
• Guide practices through the prior-authorization and appeals process, clarifying payer-specific requirements and documentation.
• Own a defined territory of retina/ophthalmology accounts and build trust as the first call for reimbursement issues.
• Lead quarterly business reviews, analyze reimbursement performance and denial trends, and devise concrete plans to fix gaps.
• Coordinate with Sales so every account gets a consistent, compliant message.
• Analyze account-level claims data to spot denial patterns, coding errors, and payer-specific quirks, and share guidance with practices.

Skills

Communication skills

Medicare/Medicaid knowledge

Payer coverage navigation

CRM systems experience

Excel proficiency

Education

Healthcare certification CPC/PAHM

Tools

Microsoft Excel

CRM systems

Job description

Outlook Therapeutics is seeking a Field Reimbursement & Access expert for a U.S. field-based role (OH, IN territory). You will be the reimbursement resource for retina practices, educate on payer policies, and guide prior authorization and appeals to support a US product launch.

You will own a defined territory, lead quarterly reviews, analyze denial trends, and collaborate with Sales to ensure consistent messaging. Travel 50–75% is required.