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

This is a fully remote position, open to applicants in United States.

📋 Description

• Strategically engage with health systems, hospitals, academic medical centers, authorized treatment facilities, provider offices, and institutional stakeholders.

• Offer education regarding access, reimbursement, and operational aspects concerning rare disease cell and gene therapy products.

• Assist in product access, treatment-site preparedness, payer coverage, prior authorization, billing, coding, denial and appeal processes, and patient access workflows.

• Act as a field-based expert in reimbursement and access, utilizing client-approved resources and compliance guidelines.

• Collaborate with client field teams, payer/access teams, patient support representatives, administrators, pharmacy, billing, finance, and clinical operation stakeholders.

• Provide education to stakeholders about acquisition pathways, specialty pharmacy, specialty distribution, buy-and-bill processes, formulary placement, coding, billing, and reimbursement strategies.

• Identify alternative funding sources, financial assistance, copay support, foundation support, and other access resources.

• Offer guidance on CGT reimbursement factors including HCPCS/CPT codes, NTAP eligibility, pass-through payment status, and strategies for reimbursement gap mitigation.

• Manage complex accounts by pinpointing access barriers, extracting customer insights, and sharing information with partners.

• Track and communicate payer coverage trends along with pertinent 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 various health systems, hospitals, treatment centers, academic medical centers, and provider sites.

• Communicate effectively with client cross-functional teams including sales representatives, account managers, and district managers.

• Monitor progress of assigned accounts while adhering to policies, procedures, rules of engagement, and performance metrics.

• Facilitate internal team training sessions and meetings.

• Act as a peer mentor and guide.

• Provide geographical support for team members and management.

• Develop and implement a business plan for the designated territory.

• Perform other related responsibilities as assigned.

⛳️ Requirements

• Bachelor’s degree is preferred.

• A 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 similar healthcare access roles.

• Proven experience working within health systems, hospitals, academic medical centers, authorized treatment centers, or similar institutional environments.

• Experience in rare diseases, cell and gene therapy, specialty biologics, oncology/hematology, neuromuscular diseases, or other complex therapeutic areas is strongly preferred.

• Progressively responsible experience directly managing institutional accounts and engaging with healthcare access stakeholders.

• Preferred experience in rare disease, specialty pharmaceuticals/biologics, or cell and gene therapy products.

• Must have Prior Authorization Certification Specialist (PACS) credentials from an industry-recognized licensing body, or be able to obtain certification within the first six months of employment.

• Capable of managing multiple client relationships, external meetings, presentations, and client interactions.

• Ability to lead and operate effectively in a matrix environment.

• Proficient in managing multiple tasks, timelines, expenses, and related activities.

• Strong judgment, decision-making capabilities, emotional intelligence, creative problem-solving, and prioritization skills.

• Skills in territory and coordination management.

• Excellent communication and presentation capabilities.

• Ability to establish and maintain relationships with business partners and healthcare professionals.

• Comprehensive understanding of health system reimbursement, physician buy-and-bill processes, institutional billing, specialty distribution, specialty pharmacy, assignment of benefits, and alternate sites of care.

• In-depth knowledge of medical and pharmacy benefits, payer policies, utilization management, prior authorization, medical necessity documentation, and appeals.

• Familiarity with private payer, Medicare, Medicaid, state Medicaid, and CMS structures, policies, and evolving payment models.

• Understanding of authorized treatment center certification, REMS obligations when applicable, treatment-site readiness, cell collection workflows, manufacturing timelines, product delivery, and continuity-of-care considerations.

• Experienced in revenue cycle, benefit investigations, prior authorization, coding, denials and appeals, formulary/medical policy navigation, and reimbursement strategies.

• Above-average proficiency in MS PowerPoint, MS Excel, MS Word, and MS Outlook.

• Must be able to reside within a reasonable commuting distance of a major airport and travel up to 80%.

🏝️ Benefits

• Medical, dental, and vision coverage.

• Backup dependent care services.

• Adoption assistance programs.

• Infertility treatment coverage.

• Family building support initiatives.

• Behavioral health solutions.

• Paid parental leave policy.

• Paid caregiver leave policy.

• Access to training programs.

• Professional development resources.

• Mentorship opportunities.

• Employee resource groups.

• Volunteer activities.