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A leading biotechnology company is seeking a Tezspire Field Reimbursement Manager to manage accounts in the respiratory therapeutic area. This role involves supporting reimbursement processes, educating healthcare providers, and resolving patient-level issues. Ideal candidates will have a strong background in medical reimbursement and excellent communication skills.
Field Reimbursement Manager, Harrisburg, PA page is loaded
Job Title: Tezspire Field Reimbursement Manager (FR M )
Job Summary: The Tezspire Field Reimbursement Manager (FR M) will manage defined accounts within a specified geographic region in the respiratory therapeutic area. This role involves supporting our products by executing the collaborative territory strategic plan . The FR M 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).
Key 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 p atient product acces s.
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.
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 office s or clinics, pharmac ies , 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
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
Working Conditions:
General office demands – Remote, Work from Home.
One to two home office days per week .
Must be able to travel up to 60 -70 % 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.
Salary Range
-Amgen is committed to unlocking the potential of biology for patients suffering from serious illnesses by discovering, developing, manufacturing and delivering innovative human therapeutics. This approach begins by using tools like advanced human genetics to unravel the complexities of disease and understand the fundamentals of human biology.
Amgen focuses on areas of high unmet medical need and leverages its biologics manufacturing expertise to strive for solutions that improve health outcomes and dramatically improve people's lives. A biotechnology pioneer since 1980, Amgen has grown to be one of the world's leading independent biotechnology companies, has reached millions of patients around the world and is developing a pipeline of medicines with breakaway potential.