Field Reimbursement Manager - Kidney (Atlanta, GA, SC)
Vertex Pharmaceuticals
4 days ago
On-site
South Carolina, United States
Market Access
General Summary
- Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP). Serve as a local subject matter expert to nephrology practices by providing non-promotional access and reimbursement education, troubleshooting to support timely patient access to prescribed Vertex kidney therapies.
Responsibilities
- Build compliant relationships with nephrology office staff involved in prior authorizations and specialty medication access.
- Partner with case management to resolve escalated access issues and ensure coordinated handoffs via CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways; follow up on case status and documentation requirements.
- Maintain understanding of commercial and government prescription coverage, payer trends, and access requirements.
- Conduct on-site and virtual in-services/trainings on payer policies, formulary/coverage nuances, PA/exception criteria, ICD-10/CPT and documentation, and distribution/hub/reimbursement workflows.
- Manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand; develop territory engagement plans.
- Follow strict non-promotional guidelines and comply with legal/compliance/privacy requirements; maintain patient confidentiality and apply program business rules.
Knowledge/Skills/Qualifications
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products; account management with HCP offices.
- Proficiency navigating payer portals, CRM systems, and field access tools; strong training/relationship and analytical skills; data/reporting ability.
- 5+ years in sales/reimbursement/market access/specialty pharmacy/patient services/field access roles.
- Deep benefits investigation and PA/appeals/coverage/payer ecosystem knowledge; Medicare/Medicaid/commercial payer expertise.
- Bachelor’s degree (health care/life sciences/business); advanced degree preferred.
- Travel 50–70%; Microsoft Office (Outlook/Word/Excel/PowerPoint) and Salesforce CRM; valid driver’s license; meet healthcare credentialing requirements.
Pay Range
- $136,000 - $204,000
- Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP). Serve as a local subject matter expert to nephrology practices by providing non-promotional access and reimbursement education, troubleshooting to support timely patient access to prescribed Vertex kidney therapies.
Responsibilities
- Build compliant relationships with nephrology office staff involved in prior authorizations and specialty medication access.
- Partner with case management to resolve escalated access issues and ensure coordinated handoffs via CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways; follow up on case status and documentation requirements.
- Maintain understanding of commercial and government prescription coverage, payer trends, and access requirements.
- Conduct on-site and virtual in-services/trainings on payer policies, formulary/coverage nuances, PA/exception criteria, ICD-10/CPT and documentation, and distribution/hub/reimbursement workflows.
- Manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand; develop territory engagement plans.
- Follow strict non-promotional guidelines and comply with legal/compliance/privacy requirements; maintain patient confidentiality and apply program business rules.
Knowledge/Skills/Qualifications
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products; account management with HCP offices.
- Proficiency navigating payer portals, CRM systems, and field access tools; strong training/relationship and analytical skills; data/reporting ability.
- 5+ years in sales/reimbursement/market access/specialty pharmacy/patient services/field access roles.
- Deep benefits investigation and PA/appeals/coverage/payer ecosystem knowledge; Medicare/Medicaid/commercial payer expertise.
- Bachelor’s degree (health care/life sciences/business); advanced degree preferred.
- Travel 50–70%; Microsoft Office (Outlook/Word/Excel/PowerPoint) and Salesforce CRM; valid driver’s license; meet healthcare credentialing requirements.
Pay Range
- $136,000 - $204,000