Field Reimbursement Manager - Kidney (Central Southwest - AZ, NM, TX, OK)
Vertex Pharmaceuticals
3 months ago
On-site
Arizona, United States
Market Access
Key Duties and Responsibilities:
- Establish compliant connections with nephrology office care team/administrative staff to support patient access to specialty medications (prior authorization/patient access).
- Partner with case management to resolve escalated access issues; coordinate handoffs via CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways to enable timely access.
- Follow up on case status and ensure offices understand insurance documentation requirements.
- Maintain understanding of commercial and government prescription coverage requirements and payer trends.
- Conduct compliant on-site/virtual in-services and training on payer policies, formulary/coverage nuances; PA/medical exception criteria; coding/billing (ICD-10, CPT) and documentation; distribution pathways, hub services, enrollment, and reimbursement workflows.
- Manage a multistate territory independently; prioritize accounts by patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to reduce patient-specific access barriers; adapt to office workflows; adhere to strict non-promotional and privacy/compliance requirements.
- Maintain confidentiality and apply program business rules for a consistent, compliant experience.
Knowledge, Skills, and Qualifications:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCPs/office staff; ability to navigate payer portals, CRM systems, and field tools.
- Strong communication, training, relationship-building, analytical skills, and data/reporting use.
- Strategic account planning; sound judgment in problem solving.
- Travel 50–70%.
- Proficiency: Outlook, Word, Excel, PowerPoint, Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
- Bachelor’s degree (health care/life sciences/business) or advanced degree (plus).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep understanding of benefits investigations, PA, appeals, coverage policies; payer knowledge (Medicare/Medicaid/commercial).
Pay/Benefits:
- $136,000–$204,000 base; eligible for annual bonus and annual equity.
- Total Rewards include medical/dental/vision, paid time off (including summer/winter shutdown), educational assistance/student loan repayment, commuting subsidy, matching charitable donations, and 401(k).
- Establish compliant connections with nephrology office care team/administrative staff to support patient access to specialty medications (prior authorization/patient access).
- Partner with case management to resolve escalated access issues; coordinate handoffs via CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways to enable timely access.
- Follow up on case status and ensure offices understand insurance documentation requirements.
- Maintain understanding of commercial and government prescription coverage requirements and payer trends.
- Conduct compliant on-site/virtual in-services and training on payer policies, formulary/coverage nuances; PA/medical exception criteria; coding/billing (ICD-10, CPT) and documentation; distribution pathways, hub services, enrollment, and reimbursement workflows.
- Manage a multistate territory independently; prioritize accounts by patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to reduce patient-specific access barriers; adapt to office workflows; adhere to strict non-promotional and privacy/compliance requirements.
- Maintain confidentiality and apply program business rules for a consistent, compliant experience.
Knowledge, Skills, and Qualifications:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCPs/office staff; ability to navigate payer portals, CRM systems, and field tools.
- Strong communication, training, relationship-building, analytical skills, and data/reporting use.
- Strategic account planning; sound judgment in problem solving.
- Travel 50–70%.
- Proficiency: Outlook, Word, Excel, PowerPoint, Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
- Bachelor’s degree (health care/life sciences/business) or advanced degree (plus).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep understanding of benefits investigations, PA, appeals, coverage policies; payer knowledge (Medicare/Medicaid/commercial).
Pay/Benefits:
- $136,000–$204,000 base; eligible for annual bonus and annual equity.
- Total Rewards include medical/dental/vision, paid time off (including summer/winter shutdown), educational assistance/student loan repayment, commuting subsidy, matching charitable donations, and 401(k).