Field Reimbursement Manager - Kidney (East Texas-Louisiana)
Vertex Pharmaceuticals
4 days ago
On-site
Louisiana, United States
Market Access
General Summary:
Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP). Serve as local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education, and supporting timely patient access via troubleshooting and payer expertise.
Key Duties And Responsibilities:
- Establish compliant relationships with nephrology office personnel (care team and prior authorization/patient access staff) to support prescribed medication access.
- Partner with case management to resolve escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways.
- Follow up on case status and ensure offices meet insurance documentation requirements.
- Maintain knowledge of commercial and government coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, formulary/coverage nuances, PA/medical exception criteria, ICD-10/CPT/coding documentation, distribution pathways/hub services/enrollment/reimbursement workflows.
- Manage a multistate region independently; prioritize accounts by patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to reduce patient access barriers; adapt to office workflows while following strict non-promotional guidelines.
- Maintain patient PHI confidentiality; apply program business rules.
Knowledge And Skills:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCP/office staff; navigate payer portals/CRM/field access tools.
- Strong communication/training/relationship-building; analytical/data reporting skills.
- Travel 50–70%; Microsoft Office and Salesforce CRM.
- Judgment/problem-solving; develop and execute account/business plans.
- Valid driver’s license; meet healthcare rep credentialing requirements.
Education And Experience:
- Bachelor’s degree (healthcare, life sciences, or 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, appeals, coverage policies, and Medicare/Medicaid/commercial.
Pay Range:
$136,000–$204,000.
Benefits (as stated):
Annual bonus and equity; medical/dental/vision, paid time off (summer/winter shutdown), educational assistance/student loan repayment, commuting subsidy, matching charitable donations, 401(k), and more.
Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP). Serve as local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education, and supporting timely patient access via troubleshooting and payer expertise.
Key Duties And Responsibilities:
- Establish compliant relationships with nephrology office personnel (care team and prior authorization/patient access staff) to support prescribed medication access.
- Partner with case management to resolve escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways.
- Follow up on case status and ensure offices meet insurance documentation requirements.
- Maintain knowledge of commercial and government coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, formulary/coverage nuances, PA/medical exception criteria, ICD-10/CPT/coding documentation, distribution pathways/hub services/enrollment/reimbursement workflows.
- Manage a multistate region independently; prioritize accounts by patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to reduce patient access barriers; adapt to office workflows while following strict non-promotional guidelines.
- Maintain patient PHI confidentiality; apply program business rules.
Knowledge And Skills:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCP/office staff; navigate payer portals/CRM/field access tools.
- Strong communication/training/relationship-building; analytical/data reporting skills.
- Travel 50–70%; Microsoft Office and Salesforce CRM.
- Judgment/problem-solving; develop and execute account/business plans.
- Valid driver’s license; meet healthcare rep credentialing requirements.
Education And Experience:
- Bachelor’s degree (healthcare, life sciences, or 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, appeals, coverage policies, and Medicare/Medicaid/commercial.
Pay Range:
$136,000–$204,000.
Benefits (as stated):
Annual bonus and equity; medical/dental/vision, paid time off (summer/winter shutdown), educational assistance/student loan repayment, commuting subsidy, matching charitable donations, 401(k), and more.