Field Reimbursement Manager - Allentown, PA

Amgen • Philadelphia, PA

2d • $145,471 - $196,813 • Remote

About The Position

The Field Reimbursement Manager manages defined accounts in a specified geographic region to support patient access and reimbursement for 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. The position also addresses patient-level reimbursement issues, including cases involving protected health information when a site specifically requests assistance.

The manager acts as an extension of the HUB, providing one-on-one coverage support and assistance throughout the reimbursement journey, from physician order through payer prior authorization, appeals, denials, and claims resolution. The role educates healthcare providers about private and public payer coverage, benefit design, formulary coverage, utilization-management criteria, insurance procedures, and available financial assistance. It coordinates access issues with relevant partners and serves as a payer expert for the assigned geography.

The territory covers Eastern and Central Pennsylvania, excluding Philadelphia. The role is remote, with customer appointments in the geography two days per week and one to two home-office days per week. Travel by automobile or plane may be up to 40%; 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; associate degree and 10 years; or high school diploma/GED and 12 years.
• 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 knowledge of Specialty Pharmacy and Buy & Bill.
• Proven presentation and facilitation skills.
• Strong written and oral communication skills.
• Organizational and project management skills, including the ability to manage multiple projects.
• Computer literacy, including Word, Excel, PowerPoint, and 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.
• Ability to collaborate and 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.
• Valid driver's license with a clean driving record.
• Ability to travel up to 40% by automobile or plane.

Nice To Haves

• Bachelor's degree in business, healthcare, or a related field.
• Six years of experience with specialty or biologic self-injectable pharmacy-benefit products or physician-administered Buy & Bill/medical-benefit products.
• Advanced knowledge of medical insurance terminology.
• Knowledge of Centers for Medicare & Medicaid Services 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 within an assigned 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.
• Support the reimbursement journey from physician order through prior authorization, appeals, denials, and claims resolution.
• Review patient-specific information when a site requests help resolving reimbursement or coverage issues.
• Educate and update healthcare providers on private and public 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 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 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

• Retirement and Savings Plan with company contributions.
• Medical, dental, and vision coverage.
• Life and 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