Field Reimbursement Manager - Kidney (Atlanta, GA, SC)
Vertex Pharmaceuticals
4 days ago
On-site
Alabama, United States
Market Access
General Summary:
Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP). Serve as local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education, and help ensure timely patient access through troubleshooting and payer expertise.
Key Duties And Responsibilities:
- Build compliant relationships with nephrology office staff involved in prior authorizations and specialty medication access.
- Partner with case management to address escalated access issues; manage coordinated handoffs via CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways.
- Follow up on case status and ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government prescription coverage and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, formulary updates, PA/medical exceptions, coding/billing (ICD-10, CPT), documentation, and reimbursement/hub workflows.
- Independently manage a multistate territory; develop engagement plans to reduce patient access barriers.
- Follow strict non-promotional, privacy, and compliance guidelines; maintain patient confidentiality.
Knowledge And Skills / Qualifications:
- Experience with specialty biologics/rare disease therapies or complex pharmacy benefit products.
- Account management experience with HCP/office staff; ability to navigate payer portals and CRM.
- Strong communication/training, analytical, and data/reporting skills.
- Strategic account planning; sound judgment.
- Travel 50–70%.
- Proficiency: Outlook, Word, Excel, PowerPoint, Salesforce CRM.
- Valid driver’s license; meet healthcare credentialing requirements.
Education And Experience:
- Bachelor’s degree (health care/life sciences/business); advanced degree preferred.
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep understanding of benefits investigations, PA, appeals, coverage policies; knowledge of Medicare/Medicaid/commercial.
Pay/Benefits:
- $136,000–$204,000 base; eligible for annual bonus and annual equity; some roles may be eligible for overtime.
- Benefits include medical/dental/vision, paid time off, educational assistance/student loan repayment, commuting subsidy, matching charitable donations, and 401(k).
Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP). Serve as local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education, and help ensure timely patient access through troubleshooting and payer expertise.
Key Duties And Responsibilities:
- Build compliant relationships with nephrology office staff involved in prior authorizations and specialty medication access.
- Partner with case management to address escalated access issues; manage coordinated handoffs via CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways.
- Follow up on case status and ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government prescription coverage and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, formulary updates, PA/medical exceptions, coding/billing (ICD-10, CPT), documentation, and reimbursement/hub workflows.
- Independently manage a multistate territory; develop engagement plans to reduce patient access barriers.
- Follow strict non-promotional, privacy, and compliance guidelines; maintain patient confidentiality.
Knowledge And Skills / Qualifications:
- Experience with specialty biologics/rare disease therapies or complex pharmacy benefit products.
- Account management experience with HCP/office staff; ability to navigate payer portals and CRM.
- Strong communication/training, analytical, and data/reporting skills.
- Strategic account planning; sound judgment.
- Travel 50–70%.
- Proficiency: Outlook, Word, Excel, PowerPoint, Salesforce CRM.
- Valid driver’s license; meet healthcare credentialing requirements.
Education And Experience:
- Bachelor’s degree (health care/life sciences/business); advanced degree preferred.
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep understanding of benefits investigations, PA, appeals, coverage policies; knowledge of Medicare/Medicaid/commercial.
Pay/Benefits:
- $136,000–$204,000 base; eligible for annual bonus and annual equity; some roles may be eligible for overtime.
- Benefits include medical/dental/vision, paid time off, educational assistance/student loan repayment, commuting subsidy, matching charitable donations, and 401(k).