Field Reimbursement Specialist

Syneos Health Commercial Solutions; Buffalo (NY); On-site; USD 155,000 - 160,000; Full time

Job summary

Syneos Health is seeking a Field Reimbursement Specialist to manage defined ophthalmic accounts across a multistate geography. You will partner with HUB, sales, market access, and providers to navigate the reimbursement landscape from prior authorizations to denials, ensuring accurate coding and billing for our products.

Ideal candidates have 2+ years in access/reimbursement and knowledge of Buy and Bill processes, with willingness to travel up to 50% and build payer relationships to remove

Qualifications

• Bachelor’s degree or 3+ years in public or private third‑party access arena or pharmaceutical industry in managed care, clinical support, and/or sales
• Minimum two years’ of access and reimbursement, managed care, and/or billing and coding support experience
• Experience with Buy and Bill products and understanding of the reimbursement process from script to injection
• Ophthalmic, retina specialists and biosimilar experience preferred
• Experience establishing relationships within a practice to remove reimbursement barriers for specialty products

Responsibilities

• Act as an extension of the product providing live one‑on‑one coverage support.
• Assist from physician order to reimbursement, supporting the entire reimbursement journey through payer prior authorization to appeals/denials requirements.
• Review patient-specific information for coverage challenges.
• Review patient insurance benefit options.
• Identify alternate funding/financial assistance programs.
• Coordinate with patient support services representatives.
• Educate physician office staff on patient assistance and call center programs.
• Provide information on reimbursement topics related to our products.
• Serve as payer expert for defined geography and communicate changes to stakeholders.
• Provide office support in accurate coding and billing for the products.

Skills

Public/Private third‑party access

Reimbursement knowledge

Billing and coding support

Ophthalmic reimbursement experience

Travel readiness

Education

Bachelor’s degree

3+ years third‑party access experience

6 years biologic coordinator experience

Job description

Description

The Field Reimbursement Specialist (FRS) will be responsible for the management of defined accounts in a specified geographic region in the ophthalmic therapeutic area, specifically supporting our client’s products.

The FRS will execute the collaborative territory strategic plan through partnership with internal and external stakeholders, which may include call center services (HUB), sales, market access, and other collaboration partners. Responsibilities include ensuring understanding of reimbursement process, field reimbursement services, and patient support program. The Reimbursement Specialist will also work on patient-level reimbursement issue resolution, and thus will need access to be knowledge of and have had experience with patient health information (PHI).

Field Reimbursement Specialists manage daily activities that support appropriate patient reimbursement to our client’s products in the provider offices and work as a liaison to other patient assistance and reimbursement support services offered by our clients. Activities include, but are not limited to:

• Act as an extension of the product providing live one‑on‑one coverage support.
• Offer assistance from physician order to reimbursement, supporting the entire reimbursement journey through payer prior authorization to appeals/denials requirements procedures and forms.
• Reviewing patient‑specific information in cases where the site has specifically requested the assistance in resolving any issues or coverage challenges.
• Reviewing patient insurance benefit options.
• Identifying alternate funding/financial assistance programs.
• Coordinating with our client’s patient support services programs representatives.
• Educating physician office staff on the use of our client’s patient assistance and call center support services, including web‑based provider programs.
• Provide information on relevant reimbursement topics related to our client’s products.
• Serve as payer expert for defined geography and able to communicate changes to key stakeholders in a timely manner.
• Provide office support in accurate coding and billing for the client’s products.

Minimum Qualifications & Education

• Bachelor’s degree or a minimum three years of experience in public or private third‑party access arena or pharmaceutical industry in managed care, clinical support, and/or sales or a minimum of 6 years biologic coordinator experience
• Minimum two years’ of access and reimbursement, managed care, and/or billing and coding support experience
• Experience working with Buy and Bill products and a thorough understanding of the entire reimbursement process from script to injection required
• Ophthalmic, retina specialists and biosimilar experience preferred
• Experience establishing relationships within a practice by working closely to help remove reimbursement barriers to specialty products for their patients
• Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare Part D (Pharmacy Benefit design and coverage policy) a plus
• Knowledge of Managed Care, Government, and Federal payer sectors, as well as Integrated Delivery Network/Integrated Health Systems a plus
• Ability to travel and cover large multistate geography territories, 50% travel required
• Excellent presentation and project management skills

The annual base salary for this position ranges from $155,000 to $160,000. The base salary range represents the anticipated low and high of the Syneos Health range for this position. Actual salary will vary based on various factors such as the candidate’s qualifications, skills, competencies, and proficiency for the role. In addition, some positions may include a company car or car allowance and eligibility to earn commissions/bonus based on company and / or individual performance.

At Syneos Health, we are dedicated to building a diverse, inclusive and authentic workplace. If your past experience doesn’t align perfectly, we encourage you to apply anyway. At times, we will consider transferable skills from previous roles. We also encourage you to join our Talent Network to stay connected to additional career opportunities.

Why Syneos Health?

Our ability to collaborate and problem‑solve makes a difference in patients’ lives daily. By joining one of our field access teams, you will partner with industry experts and be empowered to succeed with the support, resources, and autonomy needed to successfully navigate the complex reimbursement landscape. The diversification and breadth of our new and existing partnerships create a multitude of career paths and employment opportunities. Join our game‑changing, global company dedicated to creating better, smarter, faster ways to get biopharmaceutical therapies to patients. Experience the thrill of knowing that your everyday efforts are contributing to improving patients’ lives around the world.

Work Here Matters Everywhere | How are you inspired to change lives?

Syneos Health companies are affirmative action/equal opportunity employers (Minorities/Females/Veterans/Disabled)

At Syneos Health, we believe in providing an environment and culture in which Our People can thrive, develop and advance. We reward and recognize our people by providing valuable benefits and a quality‑of‑life balance. The benefits for this position will include a competitive compensation package, Health benefits to include Medical, Dental and Vision, Company match 401k, flexible paid time off (PTO) and sick time. Because certain states and municipalities have regulated paid sick time requirements, eligibility for paid sick time may vary depending on where you work. Syneos Health complies with all applicable federal, state, and municipal paid sick time requirements.

400003488