Stephen Fulton
Houston,TX
Summary
Pharmacy reimbursement and patient access leader with 15+ years of experience in specialty pharmacy, payer navigation, and provider education across rare diseases and complex therapies. Proven success in optimizing patient access, navigating payer policies, and driving cross-functional collaboration with healthcare providers, payers, and manufacturers. Actively pursuing opportunities to apply expertise as a Field Reimbursement Manager supporting provider education, access resolution, and reimbursement strategy.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Quality Review & Audit Lead Analyst
Express Scripts
05.2024 - Current
- Conduct audits across retail and LTC pharmacies, driving compliance and reimbursement accuracy.
- Educate pharmacy teams on prior authorization, appeals, and reimbursement processes.
- Collaborate with providers and manufacturers to resolve payer and access escalations.
- Analyze data to identify trends, driving corrective actions, and process efficiencies.
- Prepared detailed audit reports, summarizing findings and recommending actionable solutions.
Program Manager
Soleo Health
02.2023 - 05.2024
- Served as the primary liaison between manufacturers, payors, and internal stakeholders for rare disease therapies.
- Led provider and internal team trainings on reimbursement, access pathways, and payer policies.
- Managed HUB services ensuring compliance with SLAs and KPIs; contributed to strategic quarterly business reviews (QBRs).
- Facilitated access resolutions and prior authorization support for complex therapies.
- Led cross-functional teams to streamline program execution and improve operational efficiency.
- Developed and implemented strategic initiatives aligned with organizational goals, enhancing service delivery.
- Facilitated communication between stakeholders to ensure alignment on program objectives and progress.
- Analyzed program performance metrics, identifying areas for improvement and implementing corrective actions.
Pharmacy Reimbursement Coordinator
Orsini Specialty Pharmacy
06.2021 - 02.2023
- Conducted benefit verifications (medical and pharmacy benefits) and completed summaries of benefits.
- Acted as a liaison between payers, HCP office staff, and patients to navigate insurance requirements.
- Stayed current on payer trends and access barriers to improve patient onboarding and therapy initiation.
- Managed patient reimbursement requests, ensuring timely processing and compliance with regulations.
- Conducted thorough reviews of medical records to ensure accuracy in reimbursement submissions.
Lead Reimbursement Specialist - Subject Matter Expert
AppianRX
03.2019 - 10.2020
- Designed and implemented training protocols for reimbursement processes.
- Conducted benefit verifications, prior authorizations, and appeals support.
- Created and refined SOPs to ensure regulatory and payer policy compliance.
- Developed CRM reporting and reconciliation processes for data accuracy and access insights.
- Led reimbursement processes for complex claims, ensuring compliance with regulatory standards.
- Developed training materials that enhanced team understanding of reimbursement protocols.
Education
Master of Business Administration -
University of Houston - Clear Lake
Houston, TX05.2027
Master of Healthcare Administration - Health Care Administration
University of Houston - Clear Lake
Houston, TX05.2026
Bachelor of Arts - Business Management
University of Houston - Downtown
Houston, TX12-2024
Skills
- Field Reimbursement & Patient Access Strategy
- Provider & Payer Education
- Payer Policy Navigation (Medical & Pharmacy Benefit)
- Benefit Verification & Prior Authorization
- Specialty & Rare Disease Therapies
- Cross-Functional Collaboration
- Audit planning
- Data analytics
Certification
- Certified Pharmacy Technician (CPhT)
- Lean Six Sigma Green Belt - In Progress
- Member, American College of Healthcare Executives (ACHE)
WILLINGNESS TO RELOCATE/TRAVEL
Open to relocation within the Midwest region and travel as required for the Field Reimbursement Manager role.
Timeline
Quality Review & Audit Lead Analyst
Express Scripts
05.2024 - Current
Program Manager
Soleo Health
02.2023 - 05.2024
Pharmacy Reimbursement Coordinator
Orsini Specialty Pharmacy
06.2021 - 02.2023
Lead Reimbursement Specialist - Subject Matter Expert
AppianRX
03.2019 - 10.2020
Master of Business Administration -
University of Houston - Clear Lake
Master of Healthcare Administration - Health Care Administration
University of Houston - Clear Lake
Bachelor of Arts - Business Management
University of Houston - Downtown
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