Field Reimbursement Manager - Kidney (Atlanta, GA, SC)
Vertex Pharmaceuticals
3 months ago
On-site
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 support timely patient access through troubleshooting and territory-level payer expertise.
Key Duties and Responsibilities:
- Build compliant relationships with nephrology office care teams and administrative staff (prior authorizations/patient access).
- Partner with case management to resolve escalated access issues; coordinate handoffs via CRM triggers/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/government prescription coverage and payer trends.
- Deliver compliant on-site/virtual in-services and training on payer policies, PA/medical exception criteria, ICD-10/CPT, documentation, distribution/hub services, enrollment, and reimbursement workflows.
- Manage a multistate region; prioritize accounts by patient need, payer dynamics, and KPSP demand.
- Create territory engagement plans to minimize patient-specific access barriers.
- Adhere to non-promotional guidelines; maintain confidentiality and comply with applicable laws/regulations and company policies.
Knowledge & Skills:
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCP offices.
- Navigate payer portals and CRM/field access tools; strong training, communication, and relationship-building.
- Analytical/data skills to manage caseload and prioritize.
- Travel 50–70%; proficiency in Microsoft Office and Salesforce CRM; valid driver’s license and ability to meet credentialing.
Education & Experience:
- Bachelor’s in 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, and coverage; knowledge of Medicare/Medicaid/commercial.
Pay Range: $136,000–$204,000. Eligible for annual bonus and annual equity awards.
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 support timely patient access through troubleshooting and territory-level payer expertise.
Key Duties and Responsibilities:
- Build compliant relationships with nephrology office care teams and administrative staff (prior authorizations/patient access).
- Partner with case management to resolve escalated access issues; coordinate handoffs via CRM triggers/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/government prescription coverage and payer trends.
- Deliver compliant on-site/virtual in-services and training on payer policies, PA/medical exception criteria, ICD-10/CPT, documentation, distribution/hub services, enrollment, and reimbursement workflows.
- Manage a multistate region; prioritize accounts by patient need, payer dynamics, and KPSP demand.
- Create territory engagement plans to minimize patient-specific access barriers.
- Adhere to non-promotional guidelines; maintain confidentiality and comply with applicable laws/regulations and company policies.
Knowledge & Skills:
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCP offices.
- Navigate payer portals and CRM/field access tools; strong training, communication, and relationship-building.
- Analytical/data skills to manage caseload and prioritize.
- Travel 50–70%; proficiency in Microsoft Office and Salesforce CRM; valid driver’s license and ability to meet credentialing.
Education & Experience:
- Bachelor’s in 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, and coverage; knowledge of Medicare/Medicaid/commercial.
Pay Range: $136,000–$204,000. Eligible for annual bonus and annual equity awards.