Field Reimbursement Manager - Kidney (Central California - Los Angeles & San Bernardino)
Vertex Pharmaceuticals
3 months ago
On-site
United States
Market Access
General Summary:
- Field-based role serving as local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education, and supporting timely patient access to prescribed Vertex kidney therapies through troubleshooting and payer expertise.
Key Duties And Responsibilities:
- Establish connections with nephrology office care team and administrative staff (prior authorizations/patient access for specialty medications).
- 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 to support timely patient access.
- Provide follow-up on case status and ensure offices understand insurance documentation requirements.
- Maintain understanding of commercial and government prescription coverage requirements, access/payer trends.
- Conduct compliant on-site and virtual in-services/training covering: regional 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 geographic region; prioritize accounts based on patient need, payer dynamics, and program demand.
- Adapt engagement to office workflows; develop territory engagement plans to minimize access barriers.
- Adhere to non-promotional guidelines; follow compliance/privacy guardrails; maintain confidentiality of patient health information.
Knowledge And 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/field access tools.
- Strong communication, training, relationship-building, analytical, and data/reporting skills.
- Strategic business/account planning; sound judgment.
- Travel 50–70%; proficiency in Microsoft Outlook/Word/Excel/PowerPoint and Salesforce CRM.
- Valid driver’s license; meet healthcare industry representative credentialing requirements.
Education And Experience:
- Bachelor’s degree in health care/life sciences/business (advanced degree a plus).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles.
- Deep understanding of benefits investigations, PA processes/appeals, coverage policies, and payer ecosystems; knowledge of Medicare/Medicaid/commercial insurance.
Pay/Benefits (as stated):
- Pay range: $136,000–$204,000; eligible for annual bonus and annual equity awards.
Application instructions:
- Contact Talent Acquisition at ApplicationAssistance@vrtx.com.
- Field-based role serving as local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education, and supporting timely patient access to prescribed Vertex kidney therapies through troubleshooting and payer expertise.
Key Duties And Responsibilities:
- Establish connections with nephrology office care team and administrative staff (prior authorizations/patient access for specialty medications).
- 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 to support timely patient access.
- Provide follow-up on case status and ensure offices understand insurance documentation requirements.
- Maintain understanding of commercial and government prescription coverage requirements, access/payer trends.
- Conduct compliant on-site and virtual in-services/training covering: regional 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 geographic region; prioritize accounts based on patient need, payer dynamics, and program demand.
- Adapt engagement to office workflows; develop territory engagement plans to minimize access barriers.
- Adhere to non-promotional guidelines; follow compliance/privacy guardrails; maintain confidentiality of patient health information.
Knowledge And 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/field access tools.
- Strong communication, training, relationship-building, analytical, and data/reporting skills.
- Strategic business/account planning; sound judgment.
- Travel 50–70%; proficiency in Microsoft Outlook/Word/Excel/PowerPoint and Salesforce CRM.
- Valid driver’s license; meet healthcare industry representative credentialing requirements.
Education And Experience:
- Bachelor’s degree in health care/life sciences/business (advanced degree a plus).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles.
- Deep understanding of benefits investigations, PA processes/appeals, coverage policies, and payer ecosystems; knowledge of Medicare/Medicaid/commercial insurance.
Pay/Benefits (as stated):
- Pay range: $136,000–$204,000; eligible for annual bonus and annual equity awards.
Application instructions:
- Contact Talent Acquisition at ApplicationAssistance@vrtx.com.