Field Reimbursement Manager - Kidney (Atlanta, GA, SC)
Vertex Pharmaceuticals
4 days ago
On-site
Georgia, United States
Market Access
General Summary
- Field-based Field Reimbursement Manager (KPSP) serving as local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education, and supporting timely patient access via troubleshooting and payer expertise.
Key Duties and Responsibilities
- Build compliant relationships with nephrology office staff for prior authorizations and patient access to specialty medications.
- Partner with case management to address escalated access issues; coordinate handoffs via CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways; ensure offices complete insurance documentation.
- Follow up on case status; maintain knowledge of commercial and government coverage requirements and payer trends.
- Conduct on-site/virtual in-services/training on payer policies, formulary updates, coverage nuances; PA/medical exception criteria; coding/billing (ICD-10, CPT) and documentation; distribution/hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; develop engagement plans to reduce access barriers.
- Follow strict non-promotional, compliance, privacy, and patient confidentiality requirements; apply program rules for a consistent experience.
Knowledge/Skills & Qualifications
- Experience with specialty biologics/rare disease therapies/complex PB products; account management with HCP offices.
- Ability to navigate payer portals/CRM and use reporting/data tools.
- Strong communication/training/relationship skills; analytical and judgment/problem-solving skills.
- Travel 50–70%; valid driver’s license; MS Office and Salesforce CRM.
- 5+ years in sales/reimbursement/market access/specialty pharmacy/patient services/field access roles.
- Bachelor’s in healthcare/life sciences/business (advanced degree a plus); deep understanding of benefits investigations, PA/appeals/coverage and Medicare/Medicaid/commercial.
Pay/Benefits
- Pay range: $136,000–$204,000; eligible for annual bonus and equity; may be eligible for overtime.
- Benefits include medical/dental/vision, generous paid time off (incl. summer/winter shutdown), educational assistance (incl. student loan repayment), commuting subsidy, matching charitable donations, and 401(k).
- Field-based Field Reimbursement Manager (KPSP) serving as local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education, and supporting timely patient access via troubleshooting and payer expertise.
Key Duties and Responsibilities
- Build compliant relationships with nephrology office staff for prior authorizations and patient access to specialty medications.
- Partner with case management to address escalated access issues; coordinate handoffs via CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways; ensure offices complete insurance documentation.
- Follow up on case status; maintain knowledge of commercial and government coverage requirements and payer trends.
- Conduct on-site/virtual in-services/training on payer policies, formulary updates, coverage nuances; PA/medical exception criteria; coding/billing (ICD-10, CPT) and documentation; distribution/hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; develop engagement plans to reduce access barriers.
- Follow strict non-promotional, compliance, privacy, and patient confidentiality requirements; apply program rules for a consistent experience.
Knowledge/Skills & Qualifications
- Experience with specialty biologics/rare disease therapies/complex PB products; account management with HCP offices.
- Ability to navigate payer portals/CRM and use reporting/data tools.
- Strong communication/training/relationship skills; analytical and judgment/problem-solving skills.
- Travel 50–70%; valid driver’s license; MS Office and Salesforce CRM.
- 5+ years in sales/reimbursement/market access/specialty pharmacy/patient services/field access roles.
- Bachelor’s in healthcare/life sciences/business (advanced degree a plus); deep understanding of benefits investigations, PA/appeals/coverage and Medicare/Medicaid/commercial.
Pay/Benefits
- Pay range: $136,000–$204,000; eligible for annual bonus and equity; may be eligible for overtime.
- Benefits include medical/dental/vision, generous paid time off (incl. summer/winter shutdown), educational assistance (incl. student loan repayment), commuting subsidy, matching charitable donations, and 401(k).