Field Reimbursement Manager - Kidney (Central Southwest - AZ, NM, TX, OK)
Vertex Pharmaceuticals
4 days ago
On-site
New Mexico, United States
Market Access
General Summary
Field-based Field Reimbursement Manager (Kidney Patient Support Program, KPSP): Serve as a local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education. Ensure timely patient access through troubleshooting and payer expertise.
Key Duties and Responsibilities
- Build compliant relationships with nephrology office staff (care team and authorization/patient access administrators).
- Partner with case management on escalated access issues; coordinate handoffs via CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways; manage insurance documentation requirements.
- Maintain knowledge of commercial and government prescription coverage requirements and payer trends.
- Deliver compliant on-site/virtual in-services and training on payer policies/formulary updates, PA/medical exceptions, ICD-10/CPT coding and documentation, and distribution/hub/reimbursement workflows.
- Manage a multistate region; prioritize accounts by patient need, payer dynamics, and KPSP demand.
- Adhere to strict non-promotional guidelines; maintain patient confidentiality and comply with applicable laws/regulations and company policies.
Qualifications & Skills
- Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCP offices.
- Navigate payer portals and CRM systems; strong training/relationship-building, analytical, and data/reporting skills.
- Strategic account plan experience; judgment/problem-solving; travel 50–70%.
- Proficiency: Outlook, Word, Excel, PowerPoint, Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education & Experience
- BS in health care/life sciences/business (advanced degree preferred).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep understanding of benefits investigations, PA processes, appeals, coverage policies; knowledge of Medicare/Medicaid/commercial.
Compensation
- $136,000–$204,000 base; eligible for annual bonus and annual equity awards.
Field-based Field Reimbursement Manager (Kidney Patient Support Program, KPSP): Serve as a local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education. Ensure timely patient access through troubleshooting and payer expertise.
Key Duties and Responsibilities
- Build compliant relationships with nephrology office staff (care team and authorization/patient access administrators).
- Partner with case management on escalated access issues; coordinate handoffs via CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways; manage insurance documentation requirements.
- Maintain knowledge of commercial and government prescription coverage requirements and payer trends.
- Deliver compliant on-site/virtual in-services and training on payer policies/formulary updates, PA/medical exceptions, ICD-10/CPT coding and documentation, and distribution/hub/reimbursement workflows.
- Manage a multistate region; prioritize accounts by patient need, payer dynamics, and KPSP demand.
- Adhere to strict non-promotional guidelines; maintain patient confidentiality and comply with applicable laws/regulations and company policies.
Qualifications & Skills
- Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCP offices.
- Navigate payer portals and CRM systems; strong training/relationship-building, analytical, and data/reporting skills.
- Strategic account plan experience; judgment/problem-solving; travel 50–70%.
- Proficiency: Outlook, Word, Excel, PowerPoint, Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education & Experience
- BS in health care/life sciences/business (advanced degree preferred).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep understanding of benefits investigations, PA processes, appeals, coverage policies; knowledge of Medicare/Medicaid/commercial.
Compensation
- $136,000–$204,000 base; eligible for annual bonus and annual equity awards.