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Upsher-Smith · 17 hours ago

Field Reimbursement Manager

United States

Full-time

Onsite

Senior Level, Lead/Staff

8+ years exp

Upsher-Smith is a company focused on ensuring patient access to therapies, and they are seeking a Field Reimbursement Manager to deliver expert reimbursement and access support. This role involves educating healthcare providers on coverage and coding requirements, as well as resolving reimbursement barriers while collaborating with various teams to enhance patient access to therapy.

Health CareInformation Technology

Comp. & Benefits

Responsibilities

Educate HCP offices on access protocols, payer requirements, benefit verification, prior authorization, appeals, coding/billing, and required safety or compliance processes for our portfolio of rare disease products

Provide real-time support to resolve reimbursement, access, and specialty-pharmacy issues for both accounts and patients

Deliver payer policy updates, interpret coverage decisions, and identify access barriers or emerging trends

Facilitate appropriate use of patient support programs, hub services, copay assistance, and financial aid resources

Maintain expert knowledge of payer policies, reimbursement processes, and patient support options

Build and maintain strong relationships with Centers of Excellence, including pediatric neurology and epilepsy treatment centers within children's hospitals, by engaging HCPs and office staff involved in treatment decisions and overall patient care

Maintain strong working relationships with USL-contracted specialty pharmacies and ensure aligned engagement related to the resolution of patient -level reimbursement challenges

Support new account onboarding and training in access workflows for our portfolio of rare disease products

Monitor reimbursement trends and communicate field insights through business reviews and internal updates

Ensure timely follow-up and action planning to address account and patient needs

Collaborates with Market Access, Sales, Patient Services, Medical Affairs, marketing & external specialty-pharmacy teams to ensure aligned and compliant support

Provide field insights to guide payer strategy, patient services enhancements, and operational improvements

Contribute to reimbursement training materials, tools, and best practices

Educate and train stakeholders on coverage status, PA process, appeals and patient services

Build and maintain relationships with HCPs, office staff and health system stakeholders so that the individual is viewed as a trusted partner in support of appropriate patient therapy

Represent the organization at industry events and with patient advocacy groups

Ensure all interactions follow legal, regulatory, and company compliance requirements

Maintain accurate documentation of field activities and customer interactions

Qualification

Field reimbursement experiencePatient access knowledgeCoding knowledge ICD-10Coding knowledge CPTCoding knowledge HCPCSPACS certificationCommercial insurance understandingAnalytical skillsIntegrity & complianceCommunicationCollaboration skillsDecision-making skillsOrganization skills

Required

Bachelor's degree in business, life sciences, healthcare, or a related field

Minimum of 8 years of experience in pharmaceutical or biotech roles involving field reimbursement, patient access, specialty pharmacy, payer interactions, or managed care

Strong knowledge of medical and pharmacy benefits, coding (ICD-10, CPT, HCPCS), billing practices, and reimbursement processes

Deep understanding of commercial, Medicare, and Medicaid insurance landscapes

Demonstrated ability to analyze access trends, solve complex reimbursement issues, and present clear, simplified solutions

Excellent communication, presentation, and collaboration skills with the ability to influence without authority

Strong prioritization, decision-making, and independent working skills, with the ability to operate effectively in cross-functional teams

Although this is a virtual role, candidates should be able to travel as needed to cover large, multi-state territories; approximately 15–20% travel may be required depending on geography