Field Reimbursement Manager - Newark, NJ

Amgen • Newark, NJ

6d • Remote

About The Position

The Field Reimbursement Manager (FRM) supports Amgen’s Respiratory business unit and manages defined accounts within a specified geographic region for Patient Access and Reimbursement. The FRM supports products by executing the collaborative territory strategic plan and helping healthcare providers understand reimbursement processes, field reimbursement services, and patient support programs. The role requires patient-level reimbursement issue resolution and experience handling patient health information (PHI).

The FRM acts as an extension of the HUB, providing live, one-on-one coverage support throughout the reimbursement journey, from physician order through payer prior authorization, appeals, denials, and claims resolution. The FRM educates healthcare providers on payer coverage and changes, benefit design, formulary criteria, utilization management, insurance procedures, benefits investigations, and patient insurance and financial-assistance options. The position coordinates reimbursement issues with the HUB and other partners, serves as a payer expert for the assigned geography, and collaborates across departments to resolve access challenges.

The role is remote, with three days per week in the assigned geography for customer appointments and one to two home-office days per week. It requires travel of up to 60–80% by automobile or plane. 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.
• Have experience directly managing people and/or leadership experience leading teams, projects, or programs, or directing resource allocation; this experience may run concurrently with the required technical experience.
• Be able to travel up to 60–80% by automobile or plane.
• Have a valid driver's license and a clean driving record.

Nice To Haves

• Two years of experience in public or private third-party access or in the pharmaceutical industry in managed care, clinical support, and/or sales.
• Strong medical reimbursement experience and/or knowledge of Specialty Pharmacy and Buy & Bill.
• Proven presentation and facilitation skills.
• Strong written and oral communication skills.
• Organizational and project management experience, including the ability to manage multiple projects.
• Computer literacy, including Word, Excel, PowerPoint, and web-based meetings.
• Healthcare industry experience involving 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.
• Bachelor's degree in business, healthcare, or a related field.
• Six years of 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 for Medicare & Medicaid Services (CMS) policies and processes, with expertise in Medicare Part B for buy-and-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 within a specified geographic region for Patient Access and Reimbursement.
• Support products by executing the collaborative territory strategic plan.
• Act as an extension of the HUB and provide live, one-on-one coverage support.
• Assist healthcare providers throughout the reimbursement journey, from physician order through prior authorization, appeals, denials, and claims resolution.
• 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 a payer expert for the assigned geography and communicate payer changes promptly to stakeholders.
• Provide office education on formulary coverage, utilization management criteria, insurance forms and procedures, benefits investigations, prior authorization, 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 to resolve reimbursement issues.

Benefits

• Retirement and Savings Plan with company contributions
• Group medical coverage
• Dental coverage
• Vision coverage
• Life insurance
• Disability insurance
• Flexible spending accounts
• Discretionary annual bonus program or, for field sales representatives, a sales-based incentive plan
• Stock-based long-term incentives
• 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