Field Reimbursement Manager - Orlando, FL

Field Reimbursement Manager Orlando, FL

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

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

What we expect of you :

The field reimbursement professional we seek is a collaborator with these qualifications.

Basic Qualifications :

Doctorate degree OR

Master's degree and 3 years of customer service and / or leadership experience OR

Bachelor's degree and 5 years of customer service and / or leadership experience OR

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 meeting at least one of the above requirements, you must have experience directly managing people and / or leadership experience leading teams, projects, programs, or directing the allocation of resources. Your managerial experience may run concurrently with the required technical experience referenced above

Minimum Job Qualifications :

Minimum two years of experience in public or private third-party access arena or pharmaceutical industry in managed care, clinical support, and / or sales

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

Proven experience with hubs and in-depth knowledge of issues related to billing, coding, and appeals across physician types

Strong collaboration 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 less than 10 miles from the geography border

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

What you can expect from us :

As we work to develop treatments that take care of others, we also work to care for your professional and personal growth and well-being. From our competitive benefits to our collaborative culture, we'll support your journey every step of the way.

The expected annual salary range for this role in the U.S. (excluding Puerto Rico) is posted. Actual salary will vary based on several factors including but not limited to, relevant skills, experience, and qualifications.

In addition to the base salary, Amgen offers a Total Rewards Plan, based on eligibility, comprising of health and welfare plans for staff and eligible dependents, financial plans with opportunities to save towards retirement or other goals, work / life balance, and career development opportunities that may include :

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

Apply now and make a lasting impact with the Amgen team.