Senior Field Reimbursement Specialist- Cell and Gene Therapy/Rare Disease
Core
Field-based subject matter expert educating health systems and treatment centers on reimbursement, access, and operational logistics for rare disease cell and gene therapy products.
Role type
Senior Field Reimbursement Specialist (CGT/Rare Disease)
Builds
Patient access pathways and treatment-site readiness for high-complexity therapies
Domain
Healthcare / Cell and Gene Therapy / Rare Disease
Deliverable
client delivery
Required skills
Institutional reimbursement navigation, prior authorization management, payer policy analysis, specialty pharmacy operations, coding and billing expertise, denial/appeal processes, account management, stakeholder education, regulatory compliance (REMS), financial assistance resource identification
Preferred skills
Experience with oncology/hematology, outcomes-based agreements, value-based contracts, CMS payment models
Technologies
HCPCS/CPT codes, NTAP, CMS, Medicare, Medicaid
Responsibilities
Educate health systems on payer coverage and reimbursement for CGT products; Validate prior authorization requirements and clinical eligibility criteria; Demonstrate understanding of specialty distribution and buy-and-bill pathways; Coordinate treatment-site readiness and authorized center certification; Identify alternate funding and copay support resources; Monitor regional payer coverage trends; Deliver interactive educational presentations to institutional stakeholders; Collaborate with patient support programs and cross-functional teams; Develop and execute territory business plans.
Seniority
Senior, hands-on IC with mentorship responsibilities
