Field Reimbursement Manager - Birmingham, AL

Amgen•Montgomery, AL

3d•$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. The role supports products by executing a collaborative territory strategic plan and ensuring healthcare providers understand reimbursement processes, field reimbursement services, and patient support programs. It also involves resolving patient-level reimbursement issues, including work with patient 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 order through prior authorization, appeals, denials, and claims resolution. The position educates healthcare providers on public and private payer coverage, benefit design, coverage changes, and access processes, and coordinates issues with the HUB and other partners. The territory covers Alabama and the eastern half of Mississippi. Relocation is not included. The role is remote from a home office, with customer appointments in the 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 position may involve extended periods of sitting and keyboard work.

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 experience may run concurrently with the required technical experience.
At least 2 years of experience in the 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 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 geography or within 10 miles of its border.
Valid driver's license with a clean driving record.
Able to travel up to 40% by automobile or plane.

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 problem-solve.
Ability to manage expenses within allocated budgets.
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 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.

Responsibilities

Manage defined accounts within a specified geographic region for Patient Access and Reimbursement.
Execute the collaborative territory strategic plan in support of products.
Act as an extension of the HUB by providing live, one-on-one coverage support.
Assist healthcare provider offices throughout the reimbursement journey, including prior authorization, appeals, denials, forms, and claims resolution.
Review patient-specific information when a site requests assistance with reimbursement issues or coverage challenges.
Educate and update healthcare providers on private and public payer coverage and changes affecting 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 defined geography and communicate payer changes promptly to stakeholders.
Educate offices on formulary coverage, utilization management criteria, insurance forms and procedures, benefits investigations, prior authorization, appeals, and claims resolution 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

Health and welfare plans for staff and eligible dependents
Retirement and Savings Plan with generous company contributions
Group medical coverage
Dental coverage
Vision coverage
Life insurance
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
Career development opportunities
Flexible work models where possible