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About the Role

In this vital role, the Field Reimbursement Manager (FRM) will manage defined accounts within a specified geographic region for Patient Access and Reimbursement. This role involves supporting products by executing the collaborative territory strategic plan, ensuring an understanding of the reimbursement process, field reimbursement services, and patient support programs. The FRM will also work on patient-level reimbursement issue resolution, requiring knowledge and experience with patient health information (PHI).

Responsibilities

Act as an extension of the HUB, providing live one-on-one coverage support.
Offer assistance from physician order to reimbursement, supporting the entire reimbursement journey through payer prior authorization to appeals/denials requirements and forms.
Review patient-specific information in cases where the site has specifically requested assistance resolving any issues or coverage challenges.
Educate and update healthcare providers (HCPs) on key private and public payer coverage and changes that impact patient product access.
Coordinate access/reimbursement issues with relevant partners, including the HUB.
Provide information to HCPs on how the products are covered under the benefit design (Commercial, Medicare, Medicaid).
Serve as a payer expert for defined geography and promptly communicate payer changes to key stakeholders.
Offer office education during the access process, including formulary coverage/utilization management criteria, insurance forms & procedures, benefits investigation, prior authorization, appeal, and/or claims resolution.
Educate offices using approved materials.
Review patient insurance benefit options and alternate funding/financial assistance programs.
Collaborate with other departments to resolve reimbursement issues.

Requirements

Doctorate degree OR Master’s degree and 3 years of customer service and/or leadership experience OR Bachelor’s degree and 5 years of customer service and/or leadership experience OR Associate’s degree and 10 years of customer service and/or leadership experience OR High school diploma / GED and 12 years of customer service and/or leadership experience.
Experience directly managing people and/or leadership experience leading teams, projects, programs, or directing the allocation or resources.
Minimum two years of experience in public or private third-party access arena or pharmaceutical industry in managed care, clinical support, and/or sales.
Strong medical reimbursement experience and/or Specialty Pharmacy and Buy & Bill knowledge.
Proven presentation and facilitation skills.
Strong written and oral communication skills.
Organizational skills and project management experience, including the ability to manage multiple projects.
Strong computer literacy, including Word, Excel, and PowerPoint, and the ability to conduct web-based meetings.
Experience in the healthcare industry, including insurance verification, claim adjudication, physician's offices or clinics, pharmacies, and/or pharmaceutical manufacturers.
Proven experience with hubs and in-depth knowledge of issues related to billing, coding, and appeals across physician types.
Strong collaboration and ability to lead cross functional partner meetings.
Experience with commercial payers, Medicare plans, and state Medicaid in a geographic region.
Live in the geography or less than 10 miles from the geography border.
Bachelor's degree in business, healthcare, or a related field.
6 years' experience with specialty/biologic self-injectable (pharmacy benefit) or physician-administered (buy and bill/medical benefit) products.
Advanced knowledge of medical insurance terminology.
Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare (Part B – for buy & bill products and Part D for Pharmacy products).
Ability to manage ambiguity and problem-solve.
Ability to manage expenses within allocated budgets.
Must have a valid driver's license with a clean driving record.

Skills

Patient Access and Reimbursement
Reimbursement Process
Field Reimbursement Services
Patient Support Programs
Patient-Level Reimbursement Issue Resolution
Patient Health Information (PHI)
HUB Support
Payer Prior Authorization
Appeals/Denials
Healthcare Provider (HCP) Education
Payer Coverage
Benefit Design
Commercial Payers
Medicare
Medicaid
Payer Expert
Formulary Coverage
Utilization Management Criteria
Insurance Forms & Procedures
Benefits Investigation
Claims Resolution
Insurance Verification
Claim Adjudication
Specialty Pharmacy
Buy & Bill
Presentation Skills
Facilitation Skills
Written Communication
Oral Communication
Organizational Skills
Project Management
Computer Literacy
Microsoft Word
Microsoft Excel
Microsoft PowerPoint
Web-based Meetings
Collaboration
Cross-functional Partner Meetings
CMS Policies and Processes
Medicare Part B
Medicare Part D

Location

Brooklyn
Queens
Long Island
Remote
Work from Home

Work Type

Remote
Work from Home
Field-based (3 days a week in geography)

Experience Level

Customer Service
Leadership
Direct People Management
Team Leadership
Project Leadership
Program Leadership
Resource Allocation Direction
Third-Party Access Arena
Managed Care
Clinical Support
Sales
Medical Reimbursement
Specialty Pharmacy
Buy & Bill
Healthcare Industry
Pharmaceutical Manufacturers
Commercial Payers
Medicare Plans
State Medicaid
Specialty/Biologic Products
Physician-Administered Products

Education Level

Doctorate degree
Master’s degree
Bachelor’s degree
Associate’s degree
High school diploma / GED

Salary/Compensations

$145,471.00 to $196,813.00

Benefits

Retirement and Savings Plan with generous company contributions
Group medical, dental and vision coverage
Life and disability insurance
Flexible spending accounts
Discretionary annual bonus program or sales-based incentive plan
Stock-based long-term incentives
Award-winning time-off plans

About the Company

Amgen's Mission is to serve patients living with serious illnesses.
Since 1980, Amgen has pioneered the biotech industry in the fight against the world’s toughest diseases.
Focuses on four therapeutic areas: Oncology, Inflammation, General Medicine, and Rare Disease.
Amgen is advancing a broad and deep pipeline of medicines.
Award-winning culture is collaborative, innovative, and science-based.
Amgen is committed to unlocking the potential of biology for patients suffering from serious illnesses by discovering, developing, manufacturing and delivering innovative human therapeutics.
Uses advanced human genetics to unravel the complexities of disease and understand the fundamentals of human biology.
Focuses on areas of high unmet medical need and leverages its biologics manufacturing expertise.
A biotechnology pioneer since 1980, Amgen has grown to be one of the world's leading independent biotechnology companies.
Has reached millions of patients around the world and is developing a pipeline of medicines with breakaway potential.

Equal Opportunity

Amgen is an Equal Opportunity employer and will consider all qualified applicants for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability status, or any other basis protected by applicable law.
We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.
Please contact us to request accommodation.