Field Reimbursement Manager- Houston, Texas

Amgen • Houston, TX

2d • Remote

About The Position

Join Amgen’s Mission of Serving Patients At Amgen, if you feel like you’re part of something bigger, it’s because you are. Our shared mission—to serve patients living with serious illnesses—drives all that we do. Since 1980, we’ve helped pioneer the world of biotech in our fight against the world’s toughest diseases. With our focus on four therapeutic areas –Oncology, Inflammation, General Medicine, and Rare Disease– we reach millions of patients each year. As a member of the Amgen team, you’ll help make a lasting impact on the lives of patients as we research, manufacture, and deliver innovative medicines to help people live longer, fuller happier lives. Our award-winning culture is collaborative, innovative, and science based. If you have a passion for challenges and the opportunities that lay within them, you’ll thrive as part of the Amgen team. Join us and transform the lives of patients while transforming your career. Field Reimbursement Manager -Houston Texas What you will do Let’s do this. Let’s change the world. In this vital role the Field Reimbursement Manager will manage defined accounts within a specified geographic region for Patient Access and Reimbursement. This role involves supporting products by executing the collaborative territory strategic plan. The FRM will ensure an understanding of the reimbursement process, field reimbursement services, and patient support programs. They will also work on patient-level reimbursement issue resolution, requiring knowledge and experience with patient health information (PHI). Act as an extension of the HUB, providing live one-on-one coverage support Offer assistance from physician order to reimbursement, supporting the entire reimbursement journey through payer prior authorization to appeals/denials requirements and forms Review patient-specific information in cases where the site has specifically requested assistance resolving any issues or coverage challenges Educate and update healthcare providers (HCPs) on key private and public payer coverage and changes that impact patient product access Coordinate access/reimbursement issues with relevant partners, including the HUB Provide information to HCPs on how the products are covered under the benefit design (Commercial, Medicare, Medicaid) Serve as a payer expert for defined geography and promptly communicate payer changes to key stakeholders Offer office education during the access process, including formulary coverage/utilization management criteria, insurance forms & procedures, benefits investigation, prior authorization, appeal, and/or claims resolution Educate offices using approved materials Review patient insurance benefit options and alternate funding/financial assistance programs Collaborate with other departments to resolve reimbursement issues Working Conditions: 3 days a week in geography for customer appointments, (geography specific) General office demands – Remote, Work from Home. One to two home office days per week. Must be able to travel up to 60-80% via automobile or plane. Must have a valid driver's license with a clean driving record. Possible long periods of sitting and/or keyboard work.

Requirements

• Doctorate degree AND 2 years of experience in the public or private third-party access arena or pharmaceutical industry in managed care, clinical support, and/or sales
• Master’s degree AND 6 years of experience in the public or private third-party access arena or pharmaceutical industry in managed care, clinical support, and/or sales
• Bachelor’s degree AND 8 years of experience in the public or private third-party access arena or pharmaceutical industry in managed care, clinical support, and/or sales
• Associate degree AND 10 years of experience in the public or private third-party access arena or pharmaceutical industry in managed care, clinical support, and/or sales
• Must be able to travel up to 60-80% via automobile or plane.
• Must have a valid driver's license with a clean driving record.

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 of 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
• Strong computer literacy, including Word, Excel, and PowerPoint, and the ability to conduct web-based meetings
• Experience in the healthcare industry, including insurance verification, claim adjudication, physician's offices or clinics, pharmacies, and/or pharmaceutical manufacturers

Responsibilities

• Act as an extension of the HUB, providing live one-on-one coverage support
• Offer assistance from physician order to reimbursement, supporting the entire reimbursement journey through payer prior authorization to appeals/denials requirements and forms
• Review patient-specific information in cases where the site has specifically requested assistance resolving any issues or coverage challenges
• Educate and update healthcare providers (HCPs) on key private and public payer coverage and changes that impact patient product access
• Coordinate access/reimbursement issues with relevant partners, including the HUB
• Provide information to HCPs on how the products are covered under the benefit design (Commercial, Medicare, Medicaid)
• Serve as a payer expert for defined geography and promptly communicate payer changes to key stakeholders
• Offer office education during the access process, including formulary coverage/utilization management criteria, insurance forms & procedures, benefits investigation, prior authorization, appeal, and/or claims resolution
• Educate offices using approved materials
• Review patient insurance benefit options and alternate funding/financial assistance programs
• Collaborate with other departments to resolve reimbursement issues

Benefits

• A comprehensive employee benefits package, including a Retirement and Savings Plan with generous company contributions, group medical, dental and vision coverage, life and disability insurance, and flexible spending accounts
• A discretionary annual bonus program, or for field sales representatives, a sales-based incentive plan
• Stock-based long-term incentives
• Award-winning time-off plans
• Flexible work models, including remote and hybrid work arrangements, where possible

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees