Field Reimbursement Manager - Kidney (East Texas-Louisiana)
Vertex Pharmaceuticals
3 months ago
On-site
Texas, 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 troubleshooting to support timely patient access to prescribed Vertex kidney therapies.
Key Duties And Responsibilities:
- Compliantly build relationships with nephrology office personnel involved in prior authorizations and patient 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 understanding of insurance documentation requirements.
- Maintain knowledge of commercial and government prescription coverage and payer trends.
- Conduct compliant on-site/virtual in-services and training on payer policies, formulary/coverage nuances, PA/medical exception criteria, ICD-10/CPT coding, documentation, and reimbursement/distribution workflows.
- Manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Adhere to non-promotional and legal/compliance/privacy requirements; maintain patient confidentiality.
Knowledge And Skills (Qualifications/Requirements):
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products; account management.
- Ability to navigate payer portals/CRM and field access tools.
- Strong communication/training/relationship building; analytical and data/reporting skills.
- Experience developing and executing strategic business/account plans; sound judgment.
- Travel 50–70%.
- Proficiency: Outlook, Word, Excel, PowerPoint, Salesforce CRM.
- Valid driver’s license; meet healthcare credentialing requirements.
Education And Experience:
- Bachelor’s in healthcare/life sciences/business (advanced degree a plus).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep understanding of benefits investigations, PA processes, appeals, and coverage policies; Medicare/Medicaid/commercial payer knowledge.
Compensation/Benefits (as stated):
- Pay range: $136,000–$204,000; eligible for annual bonus and annual equity.
Total Rewards include medical/dental/vision, paid time off (incl. week-long Summer/Winter shutdown), educational assistance/student loan repayment, commuting subsidy, 401(k), and other benefits.
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 troubleshooting to support timely patient access to prescribed Vertex kidney therapies.
Key Duties And Responsibilities:
- Compliantly build relationships with nephrology office personnel involved in prior authorizations and patient 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 understanding of insurance documentation requirements.
- Maintain knowledge of commercial and government prescription coverage and payer trends.
- Conduct compliant on-site/virtual in-services and training on payer policies, formulary/coverage nuances, PA/medical exception criteria, ICD-10/CPT coding, documentation, and reimbursement/distribution workflows.
- Manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Adhere to non-promotional and legal/compliance/privacy requirements; maintain patient confidentiality.
Knowledge And Skills (Qualifications/Requirements):
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products; account management.
- Ability to navigate payer portals/CRM and field access tools.
- Strong communication/training/relationship building; analytical and data/reporting skills.
- Experience developing and executing strategic business/account plans; sound judgment.
- Travel 50–70%.
- Proficiency: Outlook, Word, Excel, PowerPoint, Salesforce CRM.
- Valid driver’s license; meet healthcare credentialing requirements.
Education And Experience:
- Bachelor’s in healthcare/life sciences/business (advanced degree a plus).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep understanding of benefits investigations, PA processes, appeals, and coverage policies; Medicare/Medicaid/commercial payer knowledge.
Compensation/Benefits (as stated):
- Pay range: $136,000–$204,000; eligible for annual bonus and annual equity.
Total Rewards include medical/dental/vision, paid time off (incl. week-long Summer/Winter shutdown), educational assistance/student loan repayment, commuting subsidy, 401(k), and other benefits.