Field Reimbursement Manager - Hartford, CT

Amgen • Bridgeport, CT

2d • $145,471 - $196,813 • Remote

About The Position

The Field Reimbursement Manager (FRM) manages defined accounts within a specified geographic region for Patient Access and Reimbursement and supports the Bone Health business unit. The role executes the collaborative territory strategic plan and helps healthcare providers understand reimbursement processes, field reimbursement services, and patient support programs. It also addresses patient-level reimbursement issues and requires working with protected health information (PHI).

The FRM acts as an extension of the HUB, providing one-on-one coverage support and assistance throughout the reimbursement journey, from physician orders and payer prior authorization through appeals, denials, and claims resolution. The role educates healthcare providers about payer coverage and changes, benefit design, formulary criteria, utilization management, insurance procedures, benefits investigation, and available patient assistance options. The FRM reviews patient-specific information when a site requests help with coverage challenges, coordinates issues with the HUB and other partners, serves as a payer expert for the assigned geography, and collaborates across departments to resolve reimbursement issues.

The position is remote and work from home, with customer appointments in the assigned geography two days per week and one to two home-office days per week. Travel of up to 40% by automobile or plane is required. A valid driver’s license and clean driving record are required. Work may involve long periods of sitting and/or keyboard use. The territory covers central and western Massachusetts and western, central, and southern Connecticut. Relocation is not included.

Requirements

• Meet one of the following education and experience combinations: doctorate degree; master’s degree and 3 years of customer service and/or leadership experience; bachelor’s degree and 5 years of customer service and/or leadership experience; 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, or programs, or directing resource allocation; this may run concurrently with the required technical experience.
• At least 2 years of experience in a public or private third-party access arena or the 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 and project management skills, including the ability to manage multiple projects.
• Strong computer literacy, including Word, Excel, and PowerPoint, and ability to conduct web-based meetings.
• Healthcare industry experience, including insurance verification, claim adjudication, physician offices or clinics, pharmacies, and/or pharmaceutical manufacturers.
• Experience with HUBs and in-depth knowledge of billing, coding, and appeals issues across physician types.
• Strong collaboration skills and ability to lead cross-functional partner meetings.
• Experience with commercial payers, Medicare plans, and state Medicaid in a geographic region.
• Live in the assigned geography or within 10 miles of its border.
• Ability to travel up to 40% by automobile or plane.
• Valid driver’s license with a clean driving record.

Nice To Haves

• Bachelor’s degree in business, healthcare, or a related field.
• 6 years of experience with specialty/biologic self-injectable products (pharmacy benefit) or physician-administered products (Buy & Bill/medical benefit).
• Advanced knowledge of medical insurance terminology.
• Knowledge of Centers for 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 solve problems.
• Ability to manage expenses within allocated budgets.

Responsibilities

• Manage defined accounts in an assigned geographic region for Patient Access and Reimbursement.
• Support products by executing the collaborative territory strategic plan.
• Act as an extension of the HUB by providing live, one-on-one coverage support.
• Assist healthcare providers from physician order through reimbursement, including prior authorization, appeals, denials, and required forms.
• Review patient-specific information when a site requests assistance resolving coverage issues or challenges.
• Educate and update healthcare providers on private and public payer coverage and changes that affect patient access.
• Coordinate access and reimbursement issues with relevant partners, including the HUB.
• Explain product coverage under commercial, Medicare, and Medicaid benefit designs.
• Serve as the payer expert for the assigned geography and promptly communicate payer changes to key stakeholders.
• Provide office education on formulary coverage, utilization management criteria, insurance forms and procedures, benefits investigations, prior authorizations, appeals, and claims resolution.
• Educate offices using approved materials.
• Review patient insurance benefit options and alternate funding or financial assistance programs.
• Collaborate with other departments and cross-functional partners to resolve reimbursement issues.

Benefits

• Retirement and Savings Plan with company contributions.
• Group medical, dental, and vision coverage.
• Life and disability insurance.
• Flexible spending accounts.
• Discretionary annual bonus program, or a sales-based incentive plan for field sales representatives.
• Stock-based long-term incentives.
• Award-winning time-off plans.
• Flexible work models where possible.
• Career development opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: No Education Listed