Field Reimbursement Manager - Seattle, WA

Amgen•Seattle, WA

10d•$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 and supports the 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. It also involves resolving patient-level reimbursement issues and handling patient health information (PHI). The FRM acts as an extension of the HUB and provides live, one-on-one coverage support throughout the reimbursement journey, from physician order through payer prior authorization, appeals, denials, and claims resolution. The role educates healthcare providers on payer coverage and changes, product benefit design, formulary coverage, utilization management, insurance processes, and available funding or financial assistance. The FRM coordinates access and reimbursement issues with the HUB and other partners, serves as a payer expert for the assigned geography, and collaborates across departments to resolve issues. The territory covers Alaska, Washington, Oregon, Idaho, and Montana. The position is remote/work from home, with customer appointments in the territory and one to two home-office days per week. Travel of up to 40% by automobile or plane is required. 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 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.
Experience directly managing people and/or leadership experience leading teams, projects, or programs, or directing resource allocation. This experience may run concurrently with the other required 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 and project management skills, including the ability to manage multiple projects.
Strong computer literacy, including Word, Excel, PowerPoint, and web-based meetings.
Healthcare industry experience in areas such as insurance verification, claim adjudication, physician offices or clinics, pharmacies, 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 assigned geography or within 10 miles of its border.
Valid driver's license and 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.
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.
Strong computer literacy, including Word, Excel, PowerPoint, and web-based meetings.
Healthcare industry experience in areas such as insurance verification, claim adjudication, physician offices or clinics, pharmacies, or pharmaceutical manufacturers.

Responsibilities

Manage defined accounts in an assigned geographic region for Patient Access and Reimbursement.
Execute the collaborative territory strategic plan in support of products and the Bone Health business unit.
Act as an extension of the HUB and provide live, one-on-one coverage support.
Assist healthcare providers from physician order through reimbursement, including payer prior authorization, appeals, denials, and related requirements and forms.
Review patient-specific information when a healthcare site requests help resolving coverage or access challenges.
Educate and update healthcare providers on private and public payer coverage and changes affecting patient access.
Coordinate access and reimbursement issues with relevant partners, including the HUB.
Explain how products are covered 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 procedures and forms, benefits investigations, prior authorizations, appeals, and claims resolution.
Educate healthcare provider offices using approved materials.
Review patient insurance benefit options and alternate funding or financial assistance programs.
Collaborate with other departments and cross-functional partners to resolve reimbursement issues.

Benefits

Retirement and Savings Plan with company contributions
Group medical coverage
Dental coverage
Vision coverage
Life insurance
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
Remote and hybrid work arrangements, where possible
Career development opportunities