Field Reimbursement Manager - Pittsburgh, PA

Amgen•Philadelphia, PA

9d•$145,471 - $196,813•Remote

About The Position

The Field Reimbursement Manager (FRM) manages defined accounts within a specified geographic region to support patient access and reimbursement for Amgen’s Bone Health business unit. The FRM supports products by executing a collaborative territory strategic plan and helps healthcare providers understand reimbursement processes, field reimbursement services, and patient support programs. The position also resolves patient-level reimbursement issues and requires knowledge and experience handling protected health information (PHI). The FRM acts as an extension of the HUB, providing one-on-one coverage support and assistance throughout the reimbursement journey, from physician orders through payer prior authorization, appeals, denials, and claims resolution. The role educates healthcare providers about public and private payer coverage, benefit designs, and coverage changes; reviews patient-specific information when offices request help; coordinates access issues with partners; and provides guidance on insurance benefits and alternate funding or financial assistance programs. The territory covers Pittsburgh and areas of northern and southern Pennsylvania, including Erie, Williamsport, and Wilkes-Barre, as well as Morgantown and Charleston, West Virginia. Relocation assistance is not included. The position is remote/work from home, with customer appointments in the geography two days per week and one to two home-office days per week. Travel of up to 40% by automobile or plane is required. A valid driver’s license and clean driving record are required. The 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’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.
In addition to the applicable education and experience combination, have experience directly managing people and/or leadership experience leading teams, projects, or programs, or directing resource allocation. This experience may run concurrently with required technical experience.
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 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 involving 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.
Ability to travel up to 40% by automobile or plane.
Valid driver’s license with a clean driving record.

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 solve problems.
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 a collaborative territory strategic plan.
Act as an extension of the HUB, providing live one-on-one coverage support.
Assist healthcare providers from physician order through reimbursement, including prior authorization, appeals, denials, and required forms.
Review patient-specific information when a site requests assistance resolving access or coverage challenges.
Educate and update healthcare providers on private and public payer coverage and changes that affect 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 stakeholders.
Provide office education about 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

Comprehensive employee benefits package, including a Retirement and Savings Plan with generous company contributions.
Group medical coverage.
Dental coverage.
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, including remote and hybrid work arrangements where possible.
Career development opportunities.