Key Responsibilities
• Serve as a reimbursement and access resource for healthcare providers and office staff across assigned products, disease states, and geographic areas.
• Provide proactive virtual reimbursement support while identifying accounts or situations that would benefit from live field engagement.
• Conduct targeted in-person visits based on reimbursement complexity, provider education needs, access barriers, account opportunity, or other defined business needs.
• Educate healthcare provider offices on payer requirements, benefit verification, prior authorization requirements, appeals processes, and available access pathways.
• Assist provider offices in understanding specialty pharmacy, specialty distribution, medical benefit, pharmacy benefit, and other applicable product access models.
• Provide education related to billing and coding requirements, claims processes, reimbursement considerations, and available client-approved resources, when applicable.
• Identify access barriers and provide appropriate education, resources, and coordination to support timely patient access to prescribed therapy.
• Monitor assigned cases and reimbursement trends to identify opportunities for proactive provider outreach and education.
• Support offices experiencing recurring reimbursement challenges, complex payer requirements, workflow barriers, or other access-related issues.
• Conduct virtual follow-up with provider offices to support continuity and efficient management of access-related needs.
• Collaborate with HUB services, case management, specialty pharmacies, account teams, sales teams, market access, patient services, and other approved stakeholders while maintaining appropriate role boundaries.
• Identify trends in payer requirements, provider workflows, and access barriers and communicate actionable insights to program leadership.
• Document all FRM activities and interactions accurately and timely within the designated CRM or technology platform.
• Strategically manage assigned accounts and geography, determining when virtual support is appropriate and when live field engagement may provide additional value.
• Participate in client meetings, training programs, business reviews, field meetings, and other program activities as required.
• Maintain current knowledge of payer policies, reimbursement requirements, program resources, and changes within the healthcare access environment.
• Ensure all activities are performed in accordance with company policies, client requirements, HIPAA, applicable laws, and Compliance and Legal guidance.
Qualifications
Required
• Bachelor's degree or equivalent combination of education and relevant professional experience.
• 3+ years of experience in field reimbursement, patient access, market access, reimbursement support, specialty pharmacy, HUB services, healthcare account management, or a related healthcare role.
• Demonstrated understanding of healthcare reimbursement and patient access processes.
• Experience with prior authorizations, appeals, payer requirements, specialty pharmacy processes, medical and/or pharmacy benefits, and reimbursement barriers.
• Strong virtual and in-person communication and presentation skills.
• Ability to analyze reimbursement challenges and determine the appropriate level of provider support.
• Ability to independently manage a broad geography and prioritize accounts based on business and access needs.
• Ability to work effectively across multiple products, disease states, and varying levels of reimbursement complexity.
• Proficiency with CRM systems, virtual communication platforms, and standard business technology.
• Ability to travel approximately 20-30%, including overnight travel as business needs require.
Preferred
• Previous FRM, reimbursement, patient access, specialty pharmacy, or HUB experience.
• Experience supporting specialty or complex therapies.
• Experience with both pharmacy-benefit and medical-benefit products.
• Knowledge of specialty pharmacy, buy-and-bill, site-of-care, infusion, or complex distribution models.
• Experience supporting multiple products or therapeutic areas.
• Experience working within a hybrid field/virtual operating model.
Core Competencies
• Access and reimbursement expertise
• Virtual and field engagement
• Provider education
• Payer and reimbursement navigation
• Case prioritization
• Complex problem solving
• Territory and workload management
• Relationship development
• Cross-functional collaboration
• Business acumen
• Adaptability across therapeutic areas
• Compliance and professional judgment
Physical Demands & Work Environment- While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit for long periods of time, use hands to type, handle or feel; and reach with hands and arms. Prefer candidates who can type at least 35 words per minute with 97% accuracy.
- Although very minimal, flexibility to travel as needed is preferred.
- This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, etc.
Any offer of employment is contingent upon the successful completion of a background check and, depending on the position, a drug screen in accordance with company standards. Please note that this job description is not intended to be an exhaustive list of all duties, responsibilities, or activities associated with the position. Responsibilities and tasks may be modified at any time, with or without notice.
