Field Reimbursement Manager - Kidney (Great Plains - NV, UT, CO, NE, KS)
Vertex Pharmaceuticals
3 days ago
On-site
Utah, United States
Market Access
Field Reimbursement Manager (Kidney Patient Support Program – KPSP)
Key Duties And Responsibilities:
- Establish connections with nephrology office care teams and administrative staff to support prior authorization and patient access to specialty medications.
- Partner with case management to address escalated access issues; manage coordinated handoffs using CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways to support timely patient access.
- Follow up on case status and ensure offices understand insurance documentation requirements.
- Maintain understanding of commercial and government insurance coverage requirements and payer trends.
- Conduct compliant on-site/virtual in-services and training on payer policies, formulary updates, coverage nuances; PA/medical exception criteria; ICD-10/CPT/coding and documentation; distribution pathways, hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts by patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize access barriers; comply with non-promotional guidelines and maintain patient confidentiality.
Knowledge, Skills, And Requirements:
- Experience with specialty biologics/rare disease therapies or complex pharmacy benefit products; account management with HCPs/office staff.
- Ability to navigate payer portals, CRM systems, and field access tools; strong training/relationship and analytical skills.
- Ability to use data/reporting to prioritize caseload.
- 50–70% travel; proficiency in Microsoft Office and Salesforce CRM.
- Bachelor’s degree (health care/life sciences/business preferred); 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep understanding of PA processes, appeals, coverage policies, and payer ecosystems; knowledge of Medicare/Medicaid/commercial.
- Valid driver’s license and ability to meet credentialing requirements.
Pay Range: $136,000 - $204,000.
Benefits (if applicable per posting): annual bonus, annual equity awards; medical/dental/vision, paid time off (incl. company shutdown), educational assistance (incl. student loan repayment), commuting subsidy, charitable donations, 401(k).
Key Duties And Responsibilities:
- Establish connections with nephrology office care teams and administrative staff to support prior authorization and patient access to specialty medications.
- Partner with case management to address escalated access issues; manage coordinated handoffs using CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways to support timely patient access.
- Follow up on case status and ensure offices understand insurance documentation requirements.
- Maintain understanding of commercial and government insurance coverage requirements and payer trends.
- Conduct compliant on-site/virtual in-services and training on payer policies, formulary updates, coverage nuances; PA/medical exception criteria; ICD-10/CPT/coding and documentation; distribution pathways, hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts by patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize access barriers; comply with non-promotional guidelines and maintain patient confidentiality.
Knowledge, Skills, And Requirements:
- Experience with specialty biologics/rare disease therapies or complex pharmacy benefit products; account management with HCPs/office staff.
- Ability to navigate payer portals, CRM systems, and field access tools; strong training/relationship and analytical skills.
- Ability to use data/reporting to prioritize caseload.
- 50–70% travel; proficiency in Microsoft Office and Salesforce CRM.
- Bachelor’s degree (health care/life sciences/business preferred); 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep understanding of PA processes, appeals, coverage policies, and payer ecosystems; knowledge of Medicare/Medicaid/commercial.
- Valid driver’s license and ability to meet credentialing requirements.
Pay Range: $136,000 - $204,000.
Benefits (if applicable per posting): annual bonus, annual equity awards; medical/dental/vision, paid time off (incl. company shutdown), educational assistance (incl. student loan repayment), commuting subsidy, charitable donations, 401(k).