Patient Access Liaison - Rare Disease - Central - Houston, TX

Patient Access Liaison (PAL)

The Patient Access Liaison (PAL) is a field-based patient access and reimbursement specialist responsible for supporting patients, caregivers, healthcare providers, and sites of care in navigating insurance coverage and reimbursement pathways for Amgen therapies. The PAL serves as a key resource in helping stakeholders understand payer requirements, prior authorization processes, reimbursement considerations, and available patient support resources. The role focuses on ensuring timely and sustained access to therapy by addressing reimbursement barriers and providing education to patients and providers on coverage and financial assistance programs. Working within a collaborative field environment, the PAL partners with internal teams including Market Access, Medical Affairs, Advocacy, Marketing, Case Management, and Site of Care teams to support the patient journey. The role operates with independence in managing assigned patient cases and contributes field insights that inform broader access strategies.

Key Responsibilities:

• Patient Access and Reimbursement Support
• Serve as a resource on patient access and reimbursement for infused and specialty therapies.
• Assist patients, caregivers, and healthcare providers in navigating insurance benefits, prior authorization requirements, and reimbursement processes.
• Support the identification and resolution of access challenges, including coverage questions, prior authorization barriers, and denied claims.
• Provide education regarding coding and billing considerations relevant to therapy access.
• Patient and Caregiver Engagement
• Develop relationships with patients and caregivers through phone, virtual, and in-person engagement.
• Secure written or electronic patient HIPAA authorization within assigned geography.
• Assess individual patient needs and provide education and resources that support access to therapy.
• Educate patients on coverage considerations and the steps required to obtain prior authorization.
• Provide information regarding co-pay assistance programs, national foundations, and free drug programs when appropriate.
• Provider and Site-of-Care Education
• Educate physician offices and sites of care on therapy coverage pathways and reimbursement processes.
• Provide information regarding common prior authorization requirements, coding considerations, and billing practices.
• Support healthcare providers and infusion centers in navigating reimbursement questions related to patient cases.
• Access Issue Resolution
• Investigate patient access challenges before and after infusion.
• Support physician offices and sites of care in reviewing denied claims and identifying potential next steps.
• Escalate complex or systemic reimbursement issues to appropriate internal stakeholders.
• Cross-Functional Collaboration
• Partner with internal stakeholders including Market Access, Medical Affairs, Advocacy, Case Managers, and Site of Care teams to support patient access initiatives.
• Coordinate with internal and external partners to ensure appropriate resources are available to support patient access.
• Share field insights regarding payer policies and reimbursement challenges.
• Compliance, Safety, and Operational Excellence
• Adhere to company policies, compliance guidance, and applicable to federal, state, and local regulations.
• Ensure activities align with HIPAA privacy requirements and internal compliance guidelines.
• Report adverse events and product complaints through established pharmacovigilance processes.
• Maintain accurate documentation of activities and interactions in Amgen's internal system.