Field Reimbursement Manager - Philadelphia, PA

Amgen • Philadelphia, PA

96d • $155,698 - $173,578 • Remote

About The Position

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. The FRM will ensure an understanding of the reimbursement process, field reimbursement services, and patient support programs. They will also work on patient-level reimbursement issue resolution, requiring knowledge and experience with patient health information (PHI). 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 of resources.
• Minimum two years of experience in public or private third-party access arena or pharmaceutical industry.
• 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.
• Strong computer literacy, including Word, Excel, and PowerPoint.
• 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 knowledge of billing, coding, and appeals.

Nice To Haves

• Bachelor's degree in business, healthcare, or a related field.
• 6 years' experience with specialty/biologic self-injectable or physician-administered products.
• Advanced knowledge of medical insurance terminology.
• Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes.
• Ability to manage ambiguity and problem-solve.
• Ability to manage expenses within allocated budgets.

Responsibilities

• Manage defined accounts within a specified geographic region for Patient Access and Reimbursement.
• Support products by executing the collaborative territory strategic plan.
• Ensure understanding of the reimbursement process, field reimbursement services, and patient support programs.
• Work on patient-level reimbursement issue resolution.
• Act as an extension of the HUB, providing live one-on-one coverage support.
• Assist from physician order to reimbursement, supporting the entire reimbursement journey.
• Review patient-specific information for assistance in resolving issues or coverage challenges.
• Educate and update healthcare providers (HCPs) on payer coverage and changes.
• Coordinate access/reimbursement issues with relevant partners.
• Provide information to HCPs on product coverage under benefit design.
• Serve as a payer expert for defined geography.
• Offer office education during the access process.
• Review patient insurance benefit options and financial assistance programs.
• Collaborate with other departments to resolve reimbursement issues.

Benefits

• Comprehensive employee benefits package including health and welfare plans.
• 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.
• Stock-based long-term incentives.
• Award-winning time-off plans.
• Flexible work models, including remote and hybrid work arrangements.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Chemical Manufacturing
• Education Level: Bachelor's degree