Field Reimbursement Manager - Kidney (Capitol - WV, VA, MD)
Vertex Pharmaceuticals
4 days ago
On-site
West Virginia, United States
Market Access
General Summary: Field-based Field Reimbursement Manager for Vertex Kidney Patient Support Program (KPSP), serving as a local subject matter expert to nephrology practices; provide non-promotional access and reimbursement education and troubleshoot for timely patient access to prescribed Vertex kidney therapies.
Key Duties and Responsibilities:
- Compliantly build relationships with nephrology office care teams and administrative staff supporting prior authorizations and access to specialty medications.
- Partner with case management to resolve escalated access issues; ensure coordinated CRM handoffs.
- 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 insurance coverage, including access and payer trends.
- Conduct compliant on-site and virtual in-services/training on payer policies, formulary updates, coverage nuances, PA/medical exception criteria, ICD-10/CPT coding and documentation, distribution/hub services, enrollment, and reimbursement workflows.
- Manage a multistate territory; prioritize accounts by patient need, payer dynamics, and KPSP demand.
- Adhere to non-promotional guidelines, confidentiality, and applicable laws/regulations.
Knowledge/Skills & Qualifications:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products; account management with HCPs/office staff.
- Ability to navigate payer portals, CRM systems, and field access tools.
- Strong communication/training/relationship building and analytical/data/reporting skills.
- Strategic business/account planning experience; sound judgment.
- Travel 50–70%.
- Proficient in MS Outlook/Word/Excel/PowerPoint and Salesforce CRM; valid driver’s license; meet healthcare rep credentialing requirements.
Education & Experience:
- Bachelor’s degree (health care, life sciences, or business); advanced degree a plus.
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field access roles.
- Deep understanding of benefits investigations, PA processes, appeals, coverage policies, and Medicare/Medicaid/commercial payers.
Compensation/Benefits (as stated): Pay range $136,000–$204,000; eligible for annual bonus and annual equity; medical/dental/vision benefits, paid time off, educational assistance/student loan repayment, commuting subsidy, matching charitable donations, and 401(k).
Key Duties and Responsibilities:
- Compliantly build relationships with nephrology office care teams and administrative staff supporting prior authorizations and access to specialty medications.
- Partner with case management to resolve escalated access issues; ensure coordinated CRM handoffs.
- 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 insurance coverage, including access and payer trends.
- Conduct compliant on-site and virtual in-services/training on payer policies, formulary updates, coverage nuances, PA/medical exception criteria, ICD-10/CPT coding and documentation, distribution/hub services, enrollment, and reimbursement workflows.
- Manage a multistate territory; prioritize accounts by patient need, payer dynamics, and KPSP demand.
- Adhere to non-promotional guidelines, confidentiality, and applicable laws/regulations.
Knowledge/Skills & Qualifications:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products; account management with HCPs/office staff.
- Ability to navigate payer portals, CRM systems, and field access tools.
- Strong communication/training/relationship building and analytical/data/reporting skills.
- Strategic business/account planning experience; sound judgment.
- Travel 50–70%.
- Proficient in MS Outlook/Word/Excel/PowerPoint and Salesforce CRM; valid driver’s license; meet healthcare rep credentialing requirements.
Education & Experience:
- Bachelor’s degree (health care, life sciences, or business); advanced degree a plus.
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field access roles.
- Deep understanding of benefits investigations, PA processes, appeals, coverage policies, and Medicare/Medicaid/commercial payers.
Compensation/Benefits (as stated): Pay range $136,000–$204,000; eligible for annual bonus and annual equity; medical/dental/vision benefits, paid time off, educational assistance/student loan repayment, commuting subsidy, matching charitable donations, and 401(k).