Field Reimbursement Manager - Kidney (Great Plains - NV, UT, CO, NE, KS)
Vertex Pharmaceuticals
4 days ago
On-site
Colorado, United States
Market Access
General Summary:
Field-based Field Reimbursement Manager for Vertex 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:
- Build compliant relationships with nephrology office personnel (care team and authorization/access staff).
- Partner with case management to address escalated access issues; use CRM triggers/workflows for coordinated handoffs.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways.
- Follow up on case status and ensure understanding of insurance documentation requirements.
- Maintain knowledge of commercial and government prescription coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, formulary updates, PA/medical exception criteria, ICD-10/CPT, documentation, distribution pathways, hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans; follow strict non-promotional guidelines; maintain patient confidentiality and comply with laws/policies.
Knowledge/Skills:
- Specialty biologics/rare disease/complext pharmacy benefit experience; account management with HCP offices.
- Ability to navigate payer portals/CRM tools; strong communication and training skills; analytical/reporting abilities.
- Travel 50–70%.
- Proficiency: Outlook, Word, Excel, PowerPoint, Salesforce CRM.
- Valid driver’s license and credentialing to access facilities.
Education/Experience:
- Bachelor’s 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, appeals, coverage policies; payer knowledge (Medicare/Medicaid/commercial).
Pay Range:
- $136,000–$204,000.
Field-based Field Reimbursement Manager for Vertex 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:
- Build compliant relationships with nephrology office personnel (care team and authorization/access staff).
- Partner with case management to address escalated access issues; use CRM triggers/workflows for coordinated handoffs.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways.
- Follow up on case status and ensure understanding of insurance documentation requirements.
- Maintain knowledge of commercial and government prescription coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, formulary updates, PA/medical exception criteria, ICD-10/CPT, documentation, distribution pathways, hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans; follow strict non-promotional guidelines; maintain patient confidentiality and comply with laws/policies.
Knowledge/Skills:
- Specialty biologics/rare disease/complext pharmacy benefit experience; account management with HCP offices.
- Ability to navigate payer portals/CRM tools; strong communication and training skills; analytical/reporting abilities.
- Travel 50–70%.
- Proficiency: Outlook, Word, Excel, PowerPoint, Salesforce CRM.
- Valid driver’s license and credentialing to access facilities.
Education/Experience:
- Bachelor’s 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, appeals, coverage policies; payer knowledge (Medicare/Medicaid/commercial).
Pay Range:
- $136,000–$204,000.