Reimbursement Specialist

Job Description

Job Description

Salary:

PositionDescription:

The Reimbursement Specialist serves as a highly skilled reimbursement and patient access resource within amanufacturer-sponsored Patient Support Services (HUB) program.As an employee of the HUB services vendor, this rolesupportspatients, healthcare providers, specialty pharmacies, and internal stakeholders byfacilitatingtimelyaccess toprescribed therapies through expert navigationof complex healthcare reimbursement processes.

The Reimbursement Specialistis responsible forconducting comprehensive benefit investigations, analyzing medical andpharmacy benefit coverage, supporting prior authorization and appeal processes,identifyingpayer -related accessbarriers, coordinating with specialty pharmacy partners, andassistinghealthcare providers with reimbursement-related

requirements.
This role requires advanced knowledge of commercial and government payer environments, specialty pharmaceuticalreimbursement pathways, patient access programs, and healthcare benefit structures. The Reimbursement Specialistmustdemonstratethe ability to independently manage complex cases, interpret payer requirements, communicateeffectively with healthcareprofessionals, anddeliver exceptional service whilemaintainingstrict compliance with manufacturer-approved program guidelines. The successful candidate will serve as a trusted reimbursement resource within a high-performing HUB environment andwill contribute to improving patient access across multiple therapeutic areas and pharmaceutical products

KeyResponsibilities:

• Comprehensive Benefit Investigation & Reimbursement Analysis

• • Conduct detailed medical and pharmacy benefit investigations for assigned products and therapeutic area

• • Analyze patient insurance coverage including:

• • Commercial insurance

• • Medicare Part B

• • Medicare Part D

• • Medicaid

• • Managed Medicaid

• • Employer-sponsored plans

• • Government-sponsored plans

• • Determinebenefit coverage requirements, including:

• • Deductibles

• Prior Authorization Support & Access Navigation

• • Review payer-specific prior authorization requirements

• • Educate provider officesregarding payer documentation expectations

• • Support completion and submission of prior authorization requests

• • Monitor authorization progress and communicate status updates

• • Identifymissing informationimpacting approval timelines

• • Support escalation of complex access issues

• • Assist providers with understanding payer processes without influencing clinical decision-making

• Appeals & Denial Resolution Support

• • Review payer denial information and identifyappropriate next steps

• • Support healthcare providers with appeal documentation requirements

• • Coordinate collection of supporting information

• • Track appeal submissions and payer outcomes

• • Identifypayer trendsimpacting patient access

• • Escalate recurring barriers to HUB leadership

• Specialty Pharmacy & Distribution Support

• • Coordinate reimbursement activities with specialty pharmacy partners.

• • Support prescription triage and fulfillment workflows.

• • Resolve reimbursement-related delaysimpactingtherapy initiation.

• • Communicate coverage outcomes and access requirements.

• • Understand specialty pharmacy network requirements and payer mandates.

• • Assistwith transitions between specialty pharmacies whenrequired
• Patient Assistance & Affordability Program Support
  • Educate patients and providers regarding available manufacturer-sponsored support programs

• • Assess patient eligibility for applicable affordability program
  • Assist with documentation requirements
  • Ensure enrollment activities are completed accurately and compliantly
• Provider Education & Customer Support
• Case Management & Documentation

MinimumQualifications:

Education

• Bachelor's degree in healthcare administration, nursing, pharmacy, life sciences, business, public health, orrelated field

• In lieu of a bachelor's degree, a minimum of five (5) years of progressive experience in:

• • Pharmaceutical HUB services

• • Specialty pharmacy

• • Patient access services

• • Healthcare reimbursement

Experience

• Experience withthree (3)years of healthcare reimbursement or patient access

• Experience working with:

• • Commercial payers

• • Medicare

• • Medicaid

• • Specialty pharmacies

• • Prior authorization platforms

Required Skills:

• Knowledge & Technical Expertise
  of:

• • Medical and pharmacy benefit structures

• • Specialty pharmacy workflows

• • Prior authorization processes

• • Appeals processes

• • Payer policies

• • PBM operations

• • Specialty medication access pathways

• • Copayassistanceprograms

• • Patientassistanceprograms

• • Reimbursement terminology

• Technology Skills
  with:

• • HUB case management platforms

• • CRM systems

• • Specialty pharmacy portals

• • Electronic prior authorization systems

• • Payer portals

• • Microsoft Office Suite

• • Reporting dashboards

Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States.

ARM is an EEO and Affirmative Action Employer of Females/Minorities/Veterans/Individuals with Disabilities.

All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law.

ARM is an Equal Opportunity Employer