Field Reimbursement Manager- Milwaukee, Wisconsin

Amgen • Milwaukee, WI

1d • $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 the collaborative territory strategic plan and ensuring understanding of reimbursement processes, field reimbursement services, and patient support programs. It includes resolving patient-level reimbursement issues and requires knowledge and experience handling patient health information (PHI).

The position covers Wisconsin, Northern Illinois, and Eastern Iowa, with the role based in the Milwaukee, Wisconsin area. Relocation is not included. The FRM acts as an extension of the HUB, supports healthcare providers through the reimbursement journey, shares information about payer coverage and benefit design, and coordinates with internal and external partners to address patient access and reimbursement challenges.

The position is remote/work from home with customer appointments in the assigned geography two days a 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 long periods of sitting and/or keyboard work. A valid driver's license and clean driving record are required.

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.
• Have experience directly managing people and/or leadership experience leading teams, projects, or programs, or directing allocation of resources. This experience may run concurrently with the required technical experience.
• At least 2 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, 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.
• 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 geography or less than 10 miles from the geography border.
• Must have a valid driver's license with a clean driving record.
• Must be able to travel up to 40% via automobile or plane.

Nice To Haves

• Bachelor's degree in business, healthcare, or a related field.
• 6 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.
• Execute the collaborative territory strategic plan in support of products.
• Provide live, one-on-one coverage support as an extension of the HUB.
• Support healthcare providers from physician order through reimbursement, including payer prior authorization, appeals, denials, requirements, and forms.
• Review patient-specific information when a site requests help resolving an issue or coverage challenge.
• Educate and update healthcare providers on private and public payer coverage and changes that affect patient product 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 promptly communicate payer changes to key stakeholders.
• Educate offices on formulary coverage and 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 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.
• Flexible work models where possible.
• Career development opportunities.
• Work/life balance plans.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED