Field Reimbursement Manager- North OC, CA

Amgen•Thousand Oaks, CA

13d•Remote

About The Position

The Field Reimbursement Manager (FRM) manages defined accounts within a specified geographic region for Patient Access and Reimbursement, supporting Amgen’s Bone Health business unit. The role executes a collaborative territory strategic plan and helps healthcare providers understand reimbursement processes, field reimbursement services, and patient support programs. It also supports patient-level reimbursement issue resolution and requires knowledge of patient health information (PHI). The FRM acts as an extension of the HUB, providing live one-on-one coverage support and assistance throughout the reimbursement journey, from physician order through payer prior authorization, appeals, denials, and claims resolution. The position educates healthcare providers about public and private payer coverage, benefit design, formulary coverage, utilization management criteria, insurance forms and procedures, benefits investigations, and financial assistance options. The FRM serves as a payer expert for the territory, communicates payer changes to stakeholders, and collaborates with the HUB and other departments to resolve access and 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. The role may involve extended periods of sitting and keyboard work. Relocation is not included. The territory covers West Covina, Torrance, Santa Ana, Anaheim, the Inland Empire, and Palm Springs, California.

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.
In addition to one of the education and experience pathways above, experience directly managing people and/or leadership experience leading teams, projects, or programs, or directing resource allocation.
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 skills and project management experience, 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.
Proven 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’ experience with specialty/biologic self-injectable products (pharmacy benefit) or physician-administered products (buy-and-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-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.
Execute the collaborative territory strategic plan in support of products.
Ensure understanding of reimbursement processes, field reimbursement services, and patient support programs.
Resolve patient-level reimbursement issues, using knowledge of patient health information (PHI).
Act as an extension of the HUB and provide live one-on-one coverage support.
Assist with 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 challenges or other issues.
Educate and update healthcare providers on public and private payer coverage 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 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 to resolve reimbursement issues.
Travel to customer appointments within the assigned geography and work from a home office.

Benefits

Retirement and Savings Plan with company contributions
Medical insurance
Dental insurance
Vision insurance
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