Senior Field Reimbursement Specialist – Cell and Gene Therapy, Rare Disease

🕒 August 4

🇺🇸 United States – Remote

💵 $93.5k - $187k / year

⏰ Full Time

🟠 Senior

😶‍🌫️ Therapist

👻 Ghost score 35%

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Cencora

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

📦 Logistics

🏥 Healthcare

Consulting • Logistics • Healthcare

Cencora is a company dedicated to improving the health and well-being of both people and animals globally. Built on the legacy of AmerisourceBergen, Cencora offers a wide range of industry-leading solutions that encompass specialty logistics, warehousing, drug research, clinical development support, and more. They provide commercialization and patient access support and offer wholesale and specialty distribution services. Cencora serves a diverse clientele, including pharmaceutical companies, physician practices, pharmacies, and health systems. The company also extends its services to animal health, managing operations and delivering products for animal pharmaceutical care. With a strong global footprint, Cencora aims to reshape healthcare delivery through innovative products and solutions, striving to create healthier futures for all.

📋 Description

• Plan and engage with health systems, hospitals, academic medical centers, authorized treatment centers, provider offices, and institutional stakeholders • Provide education on access, reimbursement, and operational considerations for rare disease cell and gene therapy products • Support product access, treatment-site readiness, payer coverage, prior authorization, billing, coding, denial and appeal processes, and patient access workflows • Serve as a field-based reimbursement and access subject matter expert using client-approved resources and compliance guidance • Collaborate with client field teams, payer/access teams, patient support representatives, administrators, pharmacy, billing, finance, and clinical operations stakeholders • Educate stakeholders on acquisition pathways, specialty pharmacy, specialty distribution, buy-and-bill, formulary placement, coding, billing, and reimbursement strategies • Identify alternate funding, financial assistance, copay support, foundation support, and other access resources • Advise on CGT reimbursement considerations including HCPCS/CPT codes, NTAP eligibility, pass-through payment status, and reimbursement gap mitigation • Manage complex accounts by identifying access barriers, uncovering customer insights, and disseminating information to partners • Monitor and communicate payer coverage trends and relevant Medicare, Medicaid, commercial payer, and CMS considerations • Coordinate with authorized treatment center coordinators, pharmacy teams, cell collection centers, and patient support representatives • Deliver educational presentations and in-services at health systems, hospitals, treatment centers, academic medical centers, and provider sites • Communicate with client cross-functional teams including sales representatives, account managers, and district managers • Track assigned-account progress while adhering to policies, procedures, rules of engagement, and performance metrics • Lead internal team training and meetings • Serve as a peer buddy and mentor • Lead geography support for team members and manager • Develop and execute a business plan for the assigned territory • Perform other related duties as assigned

🎯 Requirements

• Bachelor’s degree preferred • Minimum of 7 years of relevant experience in field reimbursement, health system access, patient access, market access, revenue cycle, managed care, institutional reimbursement support, or related healthcare access roles • Demonstrated experience working within health systems, hospitals, academic medical centers, authorized treatment centers, or comparable institutional settings • Experience with rare disease, cell and gene therapy, specialty biologics, oncology/hematology, neuromuscular disease, or other complex therapeutic areas strongly preferred • Progressively responsible experience working directly with institutional accounts and healthcare access stakeholders • Rare disease, specialty pharmaceutical/biologic, or cell and gene therapy product experience strongly preferred • Must possess Prior Authorization Certification Specialist (PACS) credentials from an industry-approved licensing body, or obtain certification within the first six months of employment • Ability to manage multiple client relationships, external meetings, presentations, and client interactions • Ability to lead and work in a matrix environment • Ability to manage multiple tasks, timelines, expenses, and related activities • Sound judgment, decision-making ability, emotional intelligence, creative problem-solving, and prioritization skills • Territory and coordination management skills • Excellent communication and presentation skills • Ability to build and maintain relationships with business partners and healthcare professionals • Broad understanding of health system reimbursement, physician buy-and-bill, institutional billing, specialty distribution, specialty pharmacy, assignment of benefits, and alternate sites of care • Deep understanding of medical and pharmacy benefits, payer policies, utilization management, prior authorization, medical necessity documentation, and appeals • Knowledge of private payer, Medicare, Medicaid, state Medicaid, and CMS structures, policies, and evolving payment models • Understanding of authorized treatment center certification, REMS obligations if applicable, treatment-site readiness, cell collection workflows, manufacturing timelines, product delivery, and continuity-of-care considerations • Experience with revenue cycle, benefit investigations, prior authorization, coding, denials and appeals, formulary/medical policy navigation, and reimbursement strategies • Above-average proficiency with MS PowerPoint, MS Excel, MS Word, and MS Outlook • Able to live within reasonable commuting distance of a major airport and travel up to 80%

🏖️ Benefits

• 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

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