Field Reimbursement Manager - Kidney (Capitol - WV, VA, MD)
Vertex Pharmaceuticals
4 days ago
On-site
Virginia, United States
Market Access
General Summary
- Field-based Field Reimbursement Manager for Kidney Patient Support Program (KPSP), serving as local subject matter expert to nephrology practices and supporting non-promotional access and reimbursement education for Vertex kidney therapies.
Key Duties and Responsibilities
- Build compliant relationships with nephrology office care team/admin staff (prior authorizations and patient access).
- Partner with case management to resolve escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways; ensure timely access.
- Follow up on case status; ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government prescription coverage requirements, payer trends.
- Conduct compliant on-site/virtual in-services and training on payer policies, formulary updates, coverage nuances, PA/medical exceptions, ICD-10/CPT/coding, documentation, distribution/hub/enrollment/reimbursement workflows.
- Manage a multistate territory independently; develop territory engagement plans to reduce access barriers.
- Adhere to non-promotional guidelines, compliance/privacy guardrails, and patient confidentiality.
Knowledge, Skills & Qualifications
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCPs/office staff.
- Ability to navigate payer portals and CRM/field access tools; strong communication/training/relationships.
- Analytical and data/reporting skills; strategic business/account planning; sound judgment.
- Travel 50–70%.
- MS Office and Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
- Bachelor’s degree (health care/life sciences/business); 5+ years in sales/reimbursement/market access/specialty pharmacy/patient services/field access.
- Deep understanding of benefits investigations, PA/appeals, coverage policies; payer knowledge (Medicare/Medicaid/commercial).
Pay/Benefits
- Pay range: $136,000–$204,000. Eligible for annual bonus and annual equity awards; may be eligible for overtime.
- Total Rewards include medical/dental/vision, generous paid time off (incl. week-long shutdown summer & winter), educational assistance/student loan repayment, commuting subsidy, matching charitable donations, and 401(k).
- Field-based Field Reimbursement Manager for Kidney Patient Support Program (KPSP), serving as local subject matter expert to nephrology practices and supporting non-promotional access and reimbursement education for Vertex kidney therapies.
Key Duties and Responsibilities
- Build compliant relationships with nephrology office care team/admin staff (prior authorizations and patient access).
- Partner with case management to resolve escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways; ensure timely access.
- Follow up on case status; ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government prescription coverage requirements, payer trends.
- Conduct compliant on-site/virtual in-services and training on payer policies, formulary updates, coverage nuances, PA/medical exceptions, ICD-10/CPT/coding, documentation, distribution/hub/enrollment/reimbursement workflows.
- Manage a multistate territory independently; develop territory engagement plans to reduce access barriers.
- Adhere to non-promotional guidelines, compliance/privacy guardrails, and patient confidentiality.
Knowledge, Skills & Qualifications
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCPs/office staff.
- Ability to navigate payer portals and CRM/field access tools; strong communication/training/relationships.
- Analytical and data/reporting skills; strategic business/account planning; sound judgment.
- Travel 50–70%.
- MS Office and Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
- Bachelor’s degree (health care/life sciences/business); 5+ years in sales/reimbursement/market access/specialty pharmacy/patient services/field access.
- Deep understanding of benefits investigations, PA/appeals, coverage policies; payer knowledge (Medicare/Medicaid/commercial).
Pay/Benefits
- Pay range: $136,000–$204,000. Eligible for annual bonus and annual equity awards; may be eligible for overtime.
- Total Rewards include medical/dental/vision, generous paid time off (incl. week-long shutdown summer & winter), educational assistance/student loan repayment, commuting subsidy, matching charitable donations, and 401(k).