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Amgen

Makes biotech medicines for serious illnesses

Field Reimbursement Manager

Clinical Support & Patient AdministrationConfirmed live in the last 24 hours
Full-timeWashington, DC, USA$145.5k - $196.8kHybrid

About the Job

Requirements

  • A doctorate, or a master's degree and 3 years of customer service and/or leadership experience, or a bachelor's degree and 5 years of customer service and/or leadership experience, or an associate's degree and 10 years of customer service and/or leadership experience, or a 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 the allocation of resources; this experience may run concurrently with the required technical experience.
  • At least 2 years of experience in public or private third-party access or the pharmaceutical industry in managed care, clinical support, and/or sales.
  • Strong medical reimbursement experience and/or knowledge of specialty pharmacy and buy-and-bill processes.
  • Presentation and facilitation skills.
  • Strong written and oral communication skills.
  • Organizational and project management experience, including the ability to manage multiple projects.
  • Computer literacy, including Microsoft 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.
  • Experience with commercial payers, Medicare plans, and state Medicaid in a geographic region.
  • Must live in the geography or within 10 miles of the geography border.
  • Must have a valid driver's license and a clean driving record.

Responsibilities

  • Manage defined accounts within a specified geographic region for Patient Access and Reimbursement.
  • Support products by executing the collaborative territory strategic plan.
  • Ensure understanding of the reimbursement process, field reimbursement services, and patient support programs.
  • Resolve patient-level reimbursement issues, using knowledge and experience with patient health information.
  • Act as an extension of the HUB by providing live one-on-one coverage support.
  • Assist from physician order through reimbursement, including payer prior authorization and appeals or denials requirements and forms.
  • Review patient-specific information when a site requests assistance resolving issues or coverage challenges.
  • Educate and update healthcare providers on key private and public payer coverage and changes affecting patient product access.
  • Coordinate access and reimbursement issues with relevant partners, including the HUB.
  • Inform healthcare providers how products are covered under commercial, Medicare, and Medicaid benefit designs.
  • Serve as a payer expert for the defined geography and promptly communicate payer changes to key stakeholders.
  • Provide office education during the access process, including formulary coverage and utilization management criteria, insurance forms and procedures, benefits investigations, prior authorization, 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.

Desired Qualifications

  • Bachelor's degree in business, healthcare, or a related field.
  • 6 years of experience with specialty/biologic self-injectable products under the pharmacy benefit or physician-administered products under buy-and-bill/medical benefits.
  • Advanced knowledge of medical insurance terminology.
  • Knowledge of Centers for Medicare & Medicaid Services policies and processes, with expertise in Medicare Part B for buy-and-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 knowledge of specialty pharmacy and buy-and-bill processes.
  • Presentation and facilitation skills.
  • Strong written and oral communication skills.
  • Organizational and project management experience, including the ability to manage multiple projects.
  • Computer literacy, including Microsoft 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.

About the Company

Amgen

Makes biotech medicines for serious illnesses

Amgen develops and makes biologic medicines, which are drugs built from proteins and antibodies grown in living cells, for serious conditions such as heart disease, cancer, and bone loss. Its anemia drug Epogen, approved in 1989, became one of the biotechnology industry's first blockbuster medicines. Amgen grows these drugs in large tanks called bioreactors, and its products include the cholesterol drug Repatha, the bone-building drug Evenity, and the severe asthma drug Tezspire. It earns money by selling these medicines, mostly through large drug wholesalers that supply hospitals and pharmacies. Amgen was founded in 1980 and is based in Thousand Oaks, California.

Company size
10,001+
Company stage
IPO
Headquarters
Thousand Oaks, CA
Founded
1980

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