Field Reimbursement Manager - Kidney (Central California - Los Angeles & San Bernardino)
Vertex Pharmaceuticals
3 days ago
On-site
California, United States
Market Access
General Summary:
- Field-based role as the local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education, supporting timely patient access through effective troubleshooting and territory-level payer expertise.
Key Duties and Responsibilities:
- Establish compliant connections with nephrology office personnel involved in prior authorizations and patient access to specialty medications.
- Partner with case management to address escalated access issues; ensure coordinated handoffs using CRM triggers and workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways.
- Follow up on case status and ensure offices understand insurance documentation requirements.
- Maintain understanding of commercial and government insurance coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies/formulary updates, PA/medical exceptions, coding/billing (ICD-10, CPT), documentation, distribution pathways, hub services, enrollment, and reimbursement workflows.
- Manage a multistate region independently; prioritize accounts by patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans; adhere to strict non-promotional guidelines and comply with legal/compliance/privacy requirements.
- Maintain confidentiality of patient health information and follow all relevant laws/regulations/company policies.
- Apply program business rules and work instructions for a consistent, compliant experience.
Knowledge and Skills:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCP/office staff; ability to navigate payer portals, CRM systems, and field access tools.
- Strong communication/training/relationship-building; analytical and data/reporting skills.
- Strategic business/account planning; sound judgment; travel 50–70%; Microsoft Office and Salesforce CRM.
- Valid driver’s license; ability to 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; payer knowledge of Medicare/Medicaid/commercial.
Pay Range (base salary):
- $136,000 - $204,000
Application/Contact:
- Contact Talent Acquisition at ApplicationAssistance@vrtx.com for application assistance.
- Field-based role as the local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education, supporting timely patient access through effective troubleshooting and territory-level payer expertise.
Key Duties and Responsibilities:
- Establish compliant connections with nephrology office personnel involved in prior authorizations and patient access to specialty medications.
- Partner with case management to address escalated access issues; ensure coordinated handoffs using CRM triggers and workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways.
- Follow up on case status and ensure offices understand insurance documentation requirements.
- Maintain understanding of commercial and government insurance coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies/formulary updates, PA/medical exceptions, coding/billing (ICD-10, CPT), documentation, distribution pathways, hub services, enrollment, and reimbursement workflows.
- Manage a multistate region independently; prioritize accounts by patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans; adhere to strict non-promotional guidelines and comply with legal/compliance/privacy requirements.
- Maintain confidentiality of patient health information and follow all relevant laws/regulations/company policies.
- Apply program business rules and work instructions for a consistent, compliant experience.
Knowledge and Skills:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCP/office staff; ability to navigate payer portals, CRM systems, and field access tools.
- Strong communication/training/relationship-building; analytical and data/reporting skills.
- Strategic business/account planning; sound judgment; travel 50–70%; Microsoft Office and Salesforce CRM.
- Valid driver’s license; ability to 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; payer knowledge of Medicare/Medicaid/commercial.
Pay Range (base salary):
- $136,000 - $204,000
Application/Contact:
- Contact Talent Acquisition at ApplicationAssistance@vrtx.com for application assistance.