Field Reimbursement Manager - Newark, NJ
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 role supports products by executing a 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, requiring knowledge of patient health information (PHI). The FRM acts as an extension of the HUB and provides live, one-on-one coverage support throughout the reimbursement journey, from physician order through payer prior authorization, appeals, denials, and claims resolution. The role educates healthcare providers about payer coverage and changes, benefit design, access procedures, insurance options, and financial assistance programs. It coordinates access and reimbursement issues with the HUB and other partners and serves as a payer expert for its defined geography. The position is remote/work-from-home with customer appointments in the assigned geography three days per week and one to two home-office days per week. Travel by automobile or plane may be up to 60–80%. Relocation is not included. The work may involve prolonged sitting and keyboard use. A valid driver’s license and clean driving record are required.
Requirements
- Doctorate degree; or a master’s degree and 3 years of customer service and/or leadership experience; or a bachelor’s degree and 5 years of customer service and/or leadership experience; or an associate’s degree and 10 years of customer service and/or leadership experience; or a 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 the allocation of resources. This experience may run concurrently with the required technical experience.
- Valid driver’s license with a clean driving record.
- Ability to travel up to 60–80% by automobile or plane.
Nice To Haves
- Two years of experience in a 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 the ability to manage multiple projects.
- Strong computer literacy, including Word, Excel, PowerPoint, and web-based meetings.
- Healthcare industry experience, including insurance verification, claim adjudication, physician’s 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.
- Bachelor’s degree in business, healthcare, or a related field.
- Six years’ 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 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.
- Act as an extension of the HUB and provide live, one-on-one coverage support.
- Assist healthcare providers from physician order through reimbursement, including payer prior authorization, appeals and denials requirements, forms, and claims resolution.
- Review patient-specific information when a site requests help resolving coverage challenges or other issues.
- 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 how products are covered under commercial, Medicare, and Medicaid benefit designs.
- Serve as a payer expert for the defined 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.
Benefits
- Health and welfare plans for staff and eligible dependents.
- 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, 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.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
No Education Listed
