Reimbursement Specialist - Medical

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Job Details

Job Description

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) to 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 include:

• 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

We provide compensation, benefits, and resources that enable a highly inclusive culture and support our team members’ ability to live with purpose every day. In addition to traditional offerings like medical, dental, and vision care, we also provide a comprehensive suite of benefits that focus on the physical, emotional, financial, and social aspects of wellness. This encompasses 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. To encourage your personal growth, we also offer a variety of training programs, professional development resources, and opportunities to participate in mentorship programs, employee resource groups, volunteer activities, and much more. For details, visit

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 View phone number on click.appcast.io or email View email address on click.appcast.io. We will make accommodation determinations on a request-by-request basis. Messages and emails regarding anything other than accommodations requests will not be returned

Affiliated Companies

Affiliated Companies: Cencora Patient Services, LLC