Bilingual Senior Patient Support Specialist

Role Summary

The Senior Patient Support Specialist (SPSS) provides personalized support for Cystic Fibrosis patients in English and Spanish, leading engagements with healthcare providers (HCPs) from CF center care teams, vendor partners, and Specialty Pharmacies. The SPSS applies commercial and government reimbursement expertise to counsel HCPs and patients on coverage requirements and acts as the subject-matter-expert in supporting patients through access and reimbursement challenges.

Responsibilities

• Develops and maintains a strategic business plan for supporting their CF patients; utilizes analytics tools to proactively monitor medication schedules and anticipate patient needs to rapidly respond to trends
• Leverages insurance, access, and reimbursement expertise to counsel HCPs on coverage requirements
• Manages multiple complex access and reimbursement challenges to completion in a time-sensitive, fast-paced environment
• Effectively escalates access, vendor, and pharmacy challenges, keeping appropriate stakeholders informed
• Maintains a comprehensive understanding of commercial and government prescription insurance coverage requirements for access and payer trends
• Assesses patient eligibility for Vertex financial assistance programs including copay and patient assistance programs; advises on complex and sensitive financial circumstances

Adherence & Education

• Sustains knowledge of approved CFTR modulators and supplemental assistance programs to provide exceptional patient support
• Anticipates and pursues opportunities throughout the treatment journey to provide Vertex treatment education and resources to mitigate adherence barriers
• Maintains strong working relationships with external partners including HCPs, HUB vendor, Specialty Distributors, and Specialty Pharmacies to maintain/increase adherence rates
• Maintains patient records and interactions in CRM; provides refill reminders and scheduling support to patients; ensures delivery, management, and monitoring of the treatment refill process
• Maintains confidentiality of patient health information and acts in compliance with all laws, regulations, and Vertex Company policies
• Demonstrates fluency and agility in supporting both Spanish and English patients

Strategic planning & advancing GPS team capabilities

• Creates a culture of compliant cross-functional collaboration, serving as a business partner to internal Vertex stakeholders such as sales and field reimbursement teams
• Interacts with sales, marketing, patient advocacy, payer teams, information technology and similar teams to provide excellent patient journey experience

Education

• Bachelor's degree

Experience

• Typically requires 3-4+ years of experience or the equivalent combination of education and experience
• Experience working with Cystic Fibrosis or other rare disease communities
• Commercial and government payer reimbursement experience
• Patient support and case management experience that includes communication with clinical care teams

Knowledge, Skills & Abilities

• Experience in payer reimbursement (including benefit investigations, prior authorizations, and appeals)
• Experience in patient support and/or case management (Pharmaceutical or biotechnology preferred)
• Working knowledge of healthcare compliance and regulatory environment
• Excellent verbal and written communication skills
• High level of empathy, experience navigating difficult conversations
• Ability to facilitate appropriate judgment in decision making and solve difficult and complex problems
• Capability to work independently with limited supervision, multitask and self-prioritize workload and demonstrate high level of agility
• Fluency in Spanish and English

Other Requirements

• Proficiency in Microsoft Outlook, Word, Excel, Power Point, Salesforce CRM or similar
• Ability to travel up to 15%, including evenings and weekends as needed
• Experience applying Motivational Interviewing techniques (preferred)
• Experience facilitating patient interactions with interpreters (preferred)
• Certified Medical interpreter in Spanish (preferred)