Field Reimbursement Manager, Miami, FL

About the role

The Field Reimbursement Manager (FRM) 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).

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
• Cook up 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

Requirements

Basic Qualifications:

• Doctorate degree
• OR Masters degree and 3 years of customer service and/or leadership experience
• OR Bachelors degree and 5 years of customer service and/or leadership experience
• OR Associates 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
• OR Experience directly managing people and/or leadership experience leading teams, projects, programs, or directing the allocation or resources

Preferred Qualifications

• 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
• Bilingual proficiency in English and Spanish, with the ability to communicate effectively in both languages
• 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 with an allocated budget
• 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

Benefits

Amgen offers 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.

In addition to the base salary, Amgen offers a Total Rewards Plan, based on eligibility, comprising of 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, and flexible work models where possible.