Patient Access Liaison – Rare Disease

This is a fully remote position, open to applicants in Florida, +5 more states.

📋 Description

• Act as a resource for patient access and reimbursement concerning infused and specialty therapies.

• Help patients, caregivers, and healthcare providers navigate insurance benefits, prior authorization requirements, and reimbursement procedures.

• Identify and address access challenges, such as coverage inquiries, prior authorization obstacles, and denied claims.

• Provide education on coding and billing considerations that are pertinent to therapy access.

• Build relationships with patients and caregivers through phone, virtual, and in-person interactions.

• Obtain written or electronic HIPAA authorization from patients within the designated geography.

• Evaluate individual patient needs and deliver education and resources that support access to therapy.

• Inform patients about coverage considerations and the steps necessary to secure prior authorization.

• Offer information on co-pay assistance programs, national foundations, and free medication programs.

• Educate physician offices and healthcare sites on therapy coverage pathways and reimbursement processes.

• Assist healthcare providers and infusion centers with reimbursement inquiries related to patient cases.

• Investigate patient access challenges both prior to and following infusion.

• Review denied claims and outline potential next steps in collaboration with physician offices and care sites.

• Elevate complex or systemic reimbursement issues to the relevant internal stakeholders.

• Collaborate with Market Access, Medical Affairs, Advocacy, Case Management, and Site of Care teams.

• Work with internal and external partners to ensure appropriate patient access resources are available.

• Share insights from the field regarding payer policies and reimbursement hurdles.

• Comply with company policies, compliance guidance, and applicable federal, state, and local regulations.

• Ensure that all activities adhere to HIPAA privacy mandates and internal compliance standards.

• Report adverse events and product complaints through established pharmacovigilance protocols.

• Maintain precise documentation within Amgen’s internal system.

⛳️ Requirements

• Doctorate degree; OR Master’s degree with 2 years of experience in patient services and/or access and reimbursement; OR Bachelor’s degree with 4 years of experience in patient services and/or access and reimbursement; OR Associate’s degree with 8 years of experience in patient services and/or access and reimbursement; OR High school diploma/GED with 10 years of experience in patient services and/or access and reimbursement (Level 5).

• Doctorate degree with 2 years of experience in patient services and/or access and reimbursement; OR Master’s degree with 4 years of experience in patient services and/or access and reimbursement; OR Bachelor’s degree with 6 years of experience in patient services and/or access and reimbursement (Level 6).

• Experience in supporting buy-and-bill or infused pharmaceutical therapies.

• Familiarity with rare diseases or orphan drugs.

• Clinical background such as nursing or allied health.

• Understanding of reimbursement processes including prior authorization, appeals, and management of denied claims.

• Knowledge of HIPAA guidelines and FDA regulatory standards.

• Awareness of internal and OIG compliance guidelines.

• Strong analytical and problem-solving capabilities.

• Excellent written and verbal communication skills.

• Ability to manage intricate patient situations and overcome access barriers.

• Experience working within cross-functional field teams.

• Proficiency in Microsoft Office, CRM, AI, and other relevant systems.

• Knowledge of access and reimbursement, prior authorization processes, healthcare reimbursement systems, coding and billing, patient support programs, compliance, and privacy requirements.

• Adaptability and learning agility.

• Quality decision-making skills.

• Stakeholder engagement abilities.

• Capability to respond swiftly to urgent access needs to avert treatment delays or interruptions.

• Ability to function effectively in matrix field environments.

• Willingness to travel up to 50%, including occasional overnight and weekend commitments.

🏝️ Benefits

• Comprehensive employee benefits package, featuring a Retirement and Savings Plan with substantial company contributions.

• Group medical, dental, and vision insurance coverage.

• Life and disability insurance.

• 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.

• Bi-annual company-wide shutdowns.

• Flexible work models, including remote work options where feasible.

• Opportunities for career development.