BioSpace
Field Reimbursement Manager - Raleigh, NC
BioSpace, Raleigh, North Carolina, United States, 27601
Field Reimbursement Manager – Raleigh, NC
BioSpace is looking for a Field Reimbursement Manager to manage defined accounts within a specified geographic region for Patient Access and Reimbursement. The role involves supporting products by executing the collaborative territory strategic plan and ensuring an understanding of the reimbursement process.
Territory Coverage New Bern, NC; Columbia, SC; Fayetteville, NC; Greenville, NC; Charleston, SC; Augusta, GA; Myrtle Beach, SC; Virginia Beach, VA
Key Responsibilities
Act as an extension of the HUB, providing live one‑on‑one coverage support.
Support the entire reimbursement journey from physician order to reimbursement, including prior authorization, appeals, and denials.
Review patient‑specific information in cases where the site has requested assistance resolving coverage challenges.
Educate and update healthcare providers (HCPs) on key payer coverage changes that impact patient product access.
Coordinate access/reimbursement issues with relevant partners, including the HUB.
Provide information to HCPs on how products are covered under commercial, Medicare, and Medicaid benefit designs.
Serve as a payer expert for defined geography and communicate payer changes to key stakeholders.
Offer office education on formulary coverage, utilization management criteria, insurance forms, 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.
Basic Qualifications
Doctorate degree OR
Masters degree and 3 years of customer service or leadership experience OR
Bachelors degree and 5 years of customer service or leadership experience OR
Associates degree and 10 years of customer service or leadership experience OR
High school diploma / GED and 12 years of customer service or leadership experience
Managerial experience leading teams or projects concurrent with the required technical experience.
Minimum Job Qualifications
Minimum two years of experience in public or private third‑party access or pharmaceutical industry in managed care, clinical support, 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.
Strong computer literacy for Word, Excel, PowerPoint, and web‑based meetings.
Experience in the healthcare industry, including insurance verification, claim adjudication, physician offices, pharmacies, and pharmaceutical manufacturers.
Proven experience with hubs and 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 or physician‑administered products.
Advanced knowledge of medical insurance terminology.
Knowledge of CMS policies and processes.
Ability to manage ambiguity and problem‑solve.
Strong presentation, facilitation, and communication skills.
Organizational and project management experience and computer literacy.
Experience in the healthcare industry.
Working Conditions
3 days a week in customer appointments.
General office demands remote, work from home.
One to two home office days per week.
Travel up to 60‑80% by automobile or plane.
Valid driver’s license and clean driving record.
Long periods of sitting or keyboard work.
Benefits and Total Rewards Competitive salary range and total rewards plan, including health and welfare plans, retirement savings, bonus program, stock‑based incentives, and flexible work models. EEO statement: Amgen is an Equal Opportunity employer and will consider all qualified applicants for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability status, or any other basis protected by applicable law.
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Territory Coverage New Bern, NC; Columbia, SC; Fayetteville, NC; Greenville, NC; Charleston, SC; Augusta, GA; Myrtle Beach, SC; Virginia Beach, VA
Key Responsibilities
Act as an extension of the HUB, providing live one‑on‑one coverage support.
Support the entire reimbursement journey from physician order to reimbursement, including prior authorization, appeals, and denials.
Review patient‑specific information in cases where the site has requested assistance resolving coverage challenges.
Educate and update healthcare providers (HCPs) on key payer coverage changes that impact patient product access.
Coordinate access/reimbursement issues with relevant partners, including the HUB.
Provide information to HCPs on how products are covered under commercial, Medicare, and Medicaid benefit designs.
Serve as a payer expert for defined geography and communicate payer changes to key stakeholders.
Offer office education on formulary coverage, utilization management criteria, insurance forms, 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.
Basic Qualifications
Doctorate degree OR
Masters degree and 3 years of customer service or leadership experience OR
Bachelors degree and 5 years of customer service or leadership experience OR
Associates degree and 10 years of customer service or leadership experience OR
High school diploma / GED and 12 years of customer service or leadership experience
Managerial experience leading teams or projects concurrent with the required technical experience.
Minimum Job Qualifications
Minimum two years of experience in public or private third‑party access or pharmaceutical industry in managed care, clinical support, 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.
Strong computer literacy for Word, Excel, PowerPoint, and web‑based meetings.
Experience in the healthcare industry, including insurance verification, claim adjudication, physician offices, pharmacies, and pharmaceutical manufacturers.
Proven experience with hubs and 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 or physician‑administered products.
Advanced knowledge of medical insurance terminology.
Knowledge of CMS policies and processes.
Ability to manage ambiguity and problem‑solve.
Strong presentation, facilitation, and communication skills.
Organizational and project management experience and computer literacy.
Experience in the healthcare industry.
Working Conditions
3 days a week in customer appointments.
General office demands remote, work from home.
One to two home office days per week.
Travel up to 60‑80% by automobile or plane.
Valid driver’s license and clean driving record.
Long periods of sitting or keyboard work.
Benefits and Total Rewards Competitive salary range and total rewards plan, including health and welfare plans, retirement savings, bonus program, stock‑based incentives, and flexible work models. EEO statement: Amgen is an Equal Opportunity employer and will consider all qualified applicants for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability status, or any other basis protected by applicable law.
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