Field Reimbursement Manager
| Company | Amgen |
|---|---|
| Location | Alexandria, LA, USA, Beaumont, TX, USA, New Orleans, LA, USA, Shreveport, LA, USA, Monroe, LA, USA, Metairie, LA, USA, Napoleonville, LA, USA, Lafayette, LA, USA, Baton Rouge, LA, USA, Lake Charles, LA, USA |
| Salary | $155968 – $173578 |
| Type | Full-Time |
| Degrees | Bachelor’s |
| Experience Level | Mid Level |
Requirements
- 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
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
- 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
Preferred Qualifications
- Bachelor’s degree in business, healthcare, or a related field
- 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