Field Reimbursement Specialist

Cencora Patient Services, LLC; North Carolina; Hybrid; USD 90,000 - 130,000; Full time

Job summary

Cencora Patient Services, LLC is seeking a Field Reimbursement Specialist (FRS) to educate provider offices on reimbursement topics and facilitate patient access to specialty medications. This role requires travel across a territory including Georgia, North Carolina, and South Carolina, with weekly in-person visits to healthcare offices.

The ideal candidate will have strong knowledge of pharmacy benefits, prior authorizations, and appeals, plus experience in revenue cycle and formulary

Qualifications

• Requires field reimbursement expertise and ability to educate providers.
• Willingness to travel up to 80% within a territory that includes GA, NC, SC.
• Prior authorization, coding, and appeals experience preferred.

Responsibilities

• Educate providers and staff on access and reimbursement topics using client-approved resources.
• Support patient access by resolving reimbursement and coverage challenges.
• Collaborate with patient assistance and reimbursement support services.
• Travel weekly to healthcare offices within the territory.
• Educate on payer policy changes and coverage considerations.

Skills

Field reimbursement expertise

Specialty pharmacy knowledge

Revenue cycle

Microsoft Office

Time management

Education

High school diploma

Bachelor's degree or relevant experience

PACS certification (within 6 months)

Tools

Microsoft Word

PowerPoint

Excel

Outlook

Job description

Our team members are at the heart of everything we do. At Cencora, we are united in our responsibility to create healthier futures, and every person here is essential to us being able to deliver on that purpose. If you want to make a difference at the center of health, come join our innovative company and help us improve the lives of people and animals everywhere.

Job Details

Please note: Interested 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 includes but may not be limited to Georgia, North Carolina, and South Carolina.

The Field Reimbursement Specialist (FRS) serves as a subject-matter expert on reimbursement, access, and coverage issues. The FRS play a critical role in ensuring patients can access specialty medications by educating healthcare providers and their staff on complex insurance and reimbursement processes and resolving access barriers. In this role, FRSs act as liaisons between providers, manufacturers, pharmacies, and payers to navigate reimbursement challenges. They meet directly with healthcare providers and their office staff to provide education on the reimbursement and access considerations specific to a specialty medication. For this position, expertise in pharmacy benefit reimbursement, prior authorizations, appeals, and specialty pharmacies is essential, as the supported medication is typically covered under pharmacy benefits.

Key responsibilities

• Educating providers and their office staff on access and reimbursement topics using client-approved resources.
• Supporting appropriate patient access to the client’s products by resolving reimbursement and coverage challenges.
• Collaborating with other patient assistance and reimbursement support services offered by the client.
• This role requires weekly travel, including potential overnight stays, to healthcare offices within a designated territory.
• FRSs use their expertise in coverage, patient assistance, and health policy to educate office staff, address access challenges, and ultimately help patients receive the medications they need.

As an FRS, a typical day might include:

• Educate provider office staff and practice managers on insurance issues relevant to the supported clients product, and inform the staff of important coverage and payer policy changes within assigned territories.
• Educate provider office staff with understanding the payers’ coverage management strategies for product, including coding, billing, formulary, prior authorization, and appeal processes.
• Probe to understand office processes and ability to discern root causes of access or reimbursement issues.
• Deliver interactive educational presentations at various provider sites of service.
• Provide information on relevant reimbursement topics related to our client’s products based on client’s approval.
• Performs other related duties as assigned.

Skills and Abilities

• Ability to conduct field-based reimbursement and access support, education, and consultation to key account customers and cross-functional partners.
• Understands the dynamics of specialty pharmacy.
• Experience in revenue cycle, formulary, benefit investigations, prior authorization, coding, and appeals processes.
• Deep understanding of pharmacy benefits/policies.
• Strong time management and planning skills.
• Proficient 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 a territory that includes but may not be limited to Georgia, North Carolina, and South Carolina.

Education and Experience

• High School Diploma/GED required.
• Bachelor's degree or relevant practice management experience preferred.
• Previous experience as Field Reimbursement Manager/Specialist preferred.
• Previous experience working in healthcare directly resolving pharmacy benefit access issues.
• Experience with extensive travel.
• Candidates must be willing to obtain a Prior Authorization Certified Specialist (PACS) certification within the first six months of employment.

What Cencora offers

• Medical, dental, and vision care
• Backup dependent care
• Adoption assistance
• Infertility coverage
• Family building support
• Behavioral health solutions
• Paid parental leave
• Paid caregiver leave
• Training programs
• Professional development resources
• Mentorship programs
• Employee resource groups
• Volunteer activities

For details, visit https://www.virtualfairhub.com/cencora

Full time Equal Employment Opportunity

Cencora is committed to providing equal employment opportunity without regard to race, color, religion, sex, sexual orientation, gender identity, genetic information, national origin, age, disability, veteran status or membership in any other class protected by federal, state or local law. The company’s continued success depends on the full and effective utilization of qualified individuals. Therefore, harassment is prohibited and all matters related to recruiting, training, compensation, benefits, promotions and transfers comply with equal opportunity principles and are non-discriminatory.

Cencora is committed to providing reasonable accommodations to individuals with disabilities during the employment process which are consistent with legal requirements. If you wish to request an accommodation while seeking employment, please call 888.692.2272 or email [e-mail]. We will make accommodation determinations on a request-by-request basis.

Affiliated Companies

Cencora Patient Services, LLC

Cencora is a leading global pharmaceutical solutions company that is committed to improving the lives of people and animals everywhere. We connect manufacturers, providers, and patients to ensure that anyone can get the therapies they need, where and when they need them. We’re a purpose-driven organization, where all of our team members around the world are united in our responsibility to create healthier futures. We work together every day to help our partners bring their innovations to patients worldwide, creating unparalleled access and impact at the center of health.