Field Reimbursement Manager - Kidney (Chicago, IL)
Vertex Pharmaceuticals
4 days ago
On-site
Illinois, 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, providing non-promotional access and reimbursement education; supporting timely patient access to prescribed Vertex kidney therapies via troubleshooting and territory-level payer expertise.
Key Duties And Responsibilities:
- Establish compliant connections with nephrology office personnel (care team and administrative staff for prior authorizations/patient access).
- Partner with case management to address escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways; provide follow-up on case status and insurance documentation requirements.
- Maintain understanding of commercial and government prescription insurance requirements and payer trends.
- Deliver on-site/virtual in-services and training on payer policies/formulary updates; PA/medical exception criteria; coding/billing (ICD-10, CPT) and documentation; distribution pathways, hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate region; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Adapt office engagement to existing workflows; develop territory engagement plans to minimize access barriers.
- Adhere to non-promotional guidelines; comply with legal/compliance/privacy guardrails.
- Maintain confidentiality of patient health information; apply program business rules and work instructions.
Knowledge And Skills:
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCPs.
- Navigate payer portals/CRM/field tools; strong communication/training/relationship building.
- Analytical and data/reporting skills to manage caseload and prioritize.
- Comfort in fast-paced, results-driven environment; strategic business/account planning; sound judgment.
- Travel 50–70%; Microsoft Office and Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education And Experience:
- Bachelor’s degree in health care/life sciences/business (advanced degree preferred).
- 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 insurance plans.
Pay Range:
$136,000 - $204,000
Total Rewards/Benefits (as stated):
- Annual bonus and annual equity awards; possible overtime eligibility.
- Medical, dental, vision; paid time off (including company shutdown); educational assistance/student loan repayment; commuting subsidy; matching charitable donations; 401(k).
Field-based Field Reimbursement Manager (Kidney Patient Support Program, KPSP) serving as a local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education; supporting timely patient access to prescribed Vertex kidney therapies via troubleshooting and territory-level payer expertise.
Key Duties And Responsibilities:
- Establish compliant connections with nephrology office personnel (care team and administrative staff for prior authorizations/patient access).
- Partner with case management to address escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways; provide follow-up on case status and insurance documentation requirements.
- Maintain understanding of commercial and government prescription insurance requirements and payer trends.
- Deliver on-site/virtual in-services and training on payer policies/formulary updates; PA/medical exception criteria; coding/billing (ICD-10, CPT) and documentation; distribution pathways, hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate region; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Adapt office engagement to existing workflows; develop territory engagement plans to minimize access barriers.
- Adhere to non-promotional guidelines; comply with legal/compliance/privacy guardrails.
- Maintain confidentiality of patient health information; apply program business rules and work instructions.
Knowledge And Skills:
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCPs.
- Navigate payer portals/CRM/field tools; strong communication/training/relationship building.
- Analytical and data/reporting skills to manage caseload and prioritize.
- Comfort in fast-paced, results-driven environment; strategic business/account planning; sound judgment.
- Travel 50–70%; Microsoft Office and Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education And Experience:
- Bachelor’s degree in health care/life sciences/business (advanced degree preferred).
- 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 insurance plans.
Pay Range:
$136,000 - $204,000
Total Rewards/Benefits (as stated):
- Annual bonus and annual equity awards; possible overtime eligibility.
- Medical, dental, vision; paid time off (including company shutdown); educational assistance/student loan repayment; commuting subsidy; matching charitable donations; 401(k).