Field Reimbursement Manager - Kidney (Capitol - WV, VA, MD)
Vertex Pharmaceuticals
7 days ago
On-site
Field Pointe, MD
Market Access
General Summary:
Field-based Field Reimbursement Manager for Vertex Kidney Patient Support Program (KPSP). Serve as a local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education, and troubleshooting to support timely patient access to prescribed Vertex kidney therapies.
Key Duties And Responsibilities:
- Build compliant relationships with nephrology care teams and administrative staff involved in prior authorizations and specialty medication access.
- Partner with case management to address escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways; provide follow-up on case status and documentation requirements.
- Maintain knowledge of commercial and government prescription insurance coverage requirements and payer trends.
- Deliver compliant on-site/virtual in-services and training on payer policies/formulary updates, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation, distribution pathways/hub services/enrollment/reimbursement workflows.
- Manage a multistate territory, prioritize accounts by patient need and payer dynamics, and develop territory engagement plans.
- Adhere to strict non-promotional guidelines; maintain patient confidentiality and comply with all applicable laws/regulations and company policies.
Knowledge And Skills / Qualifications:
- Experience with specialty biologics/rare disease/complex pharmacy benefit products; account management with HCP offices.
- Ability to navigate payer portals, CRM systems, and field access tools.
- Strong communication/training, analytical skills, data/reporting use, and judgment; travel 50–70%.
- Proficient with Microsoft Outlook/Word/Excel/PowerPoint and Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education/Experience:
- BS in healthcare/life sciences/business (advanced degree plus).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep understanding of benefits investigations, PA/appeals, coverage policies, payer ecosystems; 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 Kidney Patient Support Program (KPSP). Serve as a local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education, and troubleshooting to support timely patient access to prescribed Vertex kidney therapies.
Key Duties And Responsibilities:
- Build compliant relationships with nephrology care teams and administrative staff involved in prior authorizations and specialty medication access.
- Partner with case management to address escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways; provide follow-up on case status and documentation requirements.
- Maintain knowledge of commercial and government prescription insurance coverage requirements and payer trends.
- Deliver compliant on-site/virtual in-services and training on payer policies/formulary updates, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation, distribution pathways/hub services/enrollment/reimbursement workflows.
- Manage a multistate territory, prioritize accounts by patient need and payer dynamics, and develop territory engagement plans.
- Adhere to strict non-promotional guidelines; maintain patient confidentiality and comply with all applicable laws/regulations and company policies.
Knowledge And Skills / Qualifications:
- Experience with specialty biologics/rare disease/complex pharmacy benefit products; account management with HCP offices.
- Ability to navigate payer portals, CRM systems, and field access tools.
- Strong communication/training, analytical skills, data/reporting use, and judgment; travel 50–70%.
- Proficient with Microsoft Outlook/Word/Excel/PowerPoint and Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education/Experience:
- BS in healthcare/life sciences/business (advanced degree plus).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep understanding of benefits investigations, PA/appeals, coverage policies, payer ecosystems; knowledge of Medicare/Medicaid/commercial.
Pay Range:
$136,000–$204,000. Eligible for annual bonus and annual equity awards.