Field Reimbursement Manager - Kidney (Central Southwest - AZ, NM, TX, OK)
Vertex Pharmaceuticals
8 days ago
On-site
United States
Market Access
Field Reimbursement Manager (Kidney Patient Support Program, KPSP)
General Summary
- Field-based subject matter expert to nephrology practices providing non-promotional access and reimbursement education to support timely access to prescribed Vertex kidney therapies.
Key Duties and Responsibilities
- Build compliant relationships with nephrology office personnel involved in prior authorizations and patient access.
- Partner with case management to address escalated access issues; coordinate handoffs using CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways; ensure case status follow-up and insurance documentation requirements.
- Maintain understanding of commercial and government insurance coverage requirements and payer trends.
- Deliver compliant on-site/virtual in-services and trainings on payer policies, formulary updates, coverage nuances, PA/medical exception criteria, ICD-10/CPT, documentation, and distribution/hub/reimbursement workflows.
- Manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans; adhere to non-promotional guidelines; maintain patient confidentiality and legal/compliance requirements.
Knowledge and Skills
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCP offices.
- Navigate payer portals/CRM and field access tools; strong training/relationship-building and analytical skills.
- Travel 50–70%; proficiency in Microsoft Office and Salesforce CRM; valid driver’s license; meet facility credentialing requirements.
Education and Experience
- 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, and Medicare/Medicaid/commercial plans.
Pay Range
- $136,000–$204,000.
Benefits (if offered)
- Annual bonus and equity awards; medical/dental/vision; paid time off; education assistance (e.g., student loan repayment); commuting subsidy; 401(k).
General Summary
- Field-based subject matter expert to nephrology practices providing non-promotional access and reimbursement education to support timely access to prescribed Vertex kidney therapies.
Key Duties and Responsibilities
- Build compliant relationships with nephrology office personnel involved in prior authorizations and patient access.
- Partner with case management to address escalated access issues; coordinate handoffs using CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways; ensure case status follow-up and insurance documentation requirements.
- Maintain understanding of commercial and government insurance coverage requirements and payer trends.
- Deliver compliant on-site/virtual in-services and trainings on payer policies, formulary updates, coverage nuances, PA/medical exception criteria, ICD-10/CPT, documentation, and distribution/hub/reimbursement workflows.
- Manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans; adhere to non-promotional guidelines; maintain patient confidentiality and legal/compliance requirements.
Knowledge and Skills
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCP offices.
- Navigate payer portals/CRM and field access tools; strong training/relationship-building and analytical skills.
- Travel 50–70%; proficiency in Microsoft Office and Salesforce CRM; valid driver’s license; meet facility credentialing requirements.
Education and Experience
- 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, and Medicare/Medicaid/commercial plans.
Pay Range
- $136,000–$204,000.
Benefits (if offered)
- Annual bonus and equity awards; medical/dental/vision; paid time off; education assistance (e.g., student loan repayment); commuting subsidy; 401(k).