Field Reimbursement Manager - New York at Amgen
New York, New York, USA -
Full Time


Start Date

Immediate

Expiry Date

23 Oct, 25

Salary

173578.0

Posted On

24 Jul, 25

Experience

6 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

No

Skills

Pharmaceutical Industry, Excel, Prior Authorization, Computer Literacy, Medicare, Communication Skills, Payer, Insurance Verification, Expenses, Adjudication, Powerpoint, Managed Care, Healthcare Industry, Clinics, Clinical Support

Industry

Hospital/Health Care

Description

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.

BASIC QUALIFICATIONS:

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
OR
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
OR
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
OR
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

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
  • 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

Let’s do this. Let’s change the world. In this vital 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).

  • 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
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