Field Reimbursement Manager- Cleveland, Ohio

Amgen • Columbus, OH

21h • Remote

About The Position

The Field Reimbursement Manager (FRM) manages defined accounts within a specified geographic region for Patient Access and Reimbursement, supporting the Bone Health business unit by executing a collaborative territory strategic plan. The FRM helps healthcare providers understand the reimbursement process, field reimbursement services, and patient support programs, and resolves patient-level reimbursement issues involving protected health information when requested by a site.

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

The role is remote/work from home with customer appointments in the territory two days per week and one to two home-office days per week. Travel of up to 40% by automobile or plane is required. Relocation is not included. The position requires a valid driver’s license and clean driving record; work may involve prolonged sitting and keyboard use.

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 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 stated education and experience combinations, 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.
• At least 2 years of experience in public or private third-party access 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.
• Computer literacy, including Word, Excel, and PowerPoint, and the 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.
• Ability 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 the ability to manage multiple projects.
• Computer literacy, including Word, Excel, and PowerPoint, and the 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.
• Support Bone Health products by executing the collaborative territory strategic plan.
• Ensure healthcare providers understand reimbursement processes, field reimbursement services, and patient support programs.
• Act as an extension of the HUB and provide live one-on-one coverage support.
• Assist with reimbursement from physician order through payer prior authorization, appeals, denials, and claims resolution.
• Review patient-specific information when a site requests assistance resolving coverage or reimbursement 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 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 within the assigned territory for customer appointments and other role-related activities.

Benefits

• Comprehensive employee benefits package.
• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed