Field Reimbursement Manager - Kidney (Central Southwest - AZ, NM, TX, OK)
Vertex Pharmaceuticals
4 days ago
On-site
Texas, United States
Market Access
General Summary:
- Field-based Field Reimbursement Manager (Kidney Patient Support Program, KPSP) serving as a local subject matter expert to nephrology practices to provide non-promotional access and reimbursement education; troubleshoot and use territory payer expertise to support timely patient access to prescribed Vertex kidney therapies.
Key Duties And Responsibilities:
- Establish compliant connections with nephrology office staff involved in prior authorizations and specialty medication access.
- Partner with case management to address escalated access issues; ensure coordinated 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 understanding of commercial and government prescription insurance coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on regional payer policies, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation requirements, distribution/hub services, enrollment processes, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts by patient need, payer dynamics, and KPSP demand; adapt to office workflows.
- Develop territory engagement plans; adhere to strict non-promotional guidelines; maintain patient confidentiality and comply with applicable laws/regulations and company policies; apply program business rules.
Knowledge And Skills:
- Specialty biologics/rare disease therapies or complex pharmacy benefit experience; account management with HCPs/office staff; navigate payer portals/CRM/tools.
- Strong communication, training, relationship-building, analytical, and data/reporting skills; comfortable in fast-paced environment; experience developing/executing account plans.
- Travel 50–70%; proficiency in Microsoft Office and Salesforce CRM.
- Valid driver’s license; meet industry representative credentialing requirements.
Education And Experience:
- Bachelor’s degree in health care, life sciences, or 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, and commercial plans.
Pay/Benefits:
- Base pay range: $136,000 - $204,000; annual bonus and annual equity awards; may be eligible for overtime pay (per law).
- Total Rewards benefits include medical/dental/vision, paid time off (including summer/winter shutdown), educational assistance (student loan repayment), commuting subsidy, matching charitable donations, 401(k), and more.
Application Instructions:
- Contact recruiter/hiring manager or Talent Acquisition at ApplicationAssistance@vrtx.com for accommodation requests related to the hiring process and/or essential functions.
- Field-based Field Reimbursement Manager (Kidney Patient Support Program, KPSP) serving as a local subject matter expert to nephrology practices to provide non-promotional access and reimbursement education; troubleshoot and use territory payer expertise to support timely patient access to prescribed Vertex kidney therapies.
Key Duties And Responsibilities:
- Establish compliant connections with nephrology office staff involved in prior authorizations and specialty medication access.
- Partner with case management to address escalated access issues; ensure coordinated 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 understanding of commercial and government prescription insurance coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on regional payer policies, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation requirements, distribution/hub services, enrollment processes, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts by patient need, payer dynamics, and KPSP demand; adapt to office workflows.
- Develop territory engagement plans; adhere to strict non-promotional guidelines; maintain patient confidentiality and comply with applicable laws/regulations and company policies; apply program business rules.
Knowledge And Skills:
- Specialty biologics/rare disease therapies or complex pharmacy benefit experience; account management with HCPs/office staff; navigate payer portals/CRM/tools.
- Strong communication, training, relationship-building, analytical, and data/reporting skills; comfortable in fast-paced environment; experience developing/executing account plans.
- Travel 50–70%; proficiency in Microsoft Office and Salesforce CRM.
- Valid driver’s license; meet industry representative credentialing requirements.
Education And Experience:
- Bachelor’s degree in health care, life sciences, or 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, and commercial plans.
Pay/Benefits:
- Base pay range: $136,000 - $204,000; annual bonus and annual equity awards; may be eligible for overtime pay (per law).
- Total Rewards benefits include medical/dental/vision, paid time off (including summer/winter shutdown), educational assistance (student loan repayment), commuting subsidy, matching charitable donations, 401(k), and more.
Application Instructions:
- Contact recruiter/hiring manager or Talent Acquisition at ApplicationAssistance@vrtx.com for accommodation requests related to the hiring process and/or essential functions.