Field Reimbursement Manager - Kidney (Great Plains - NV, UT, CO, NE, KS)
Vertex Pharmaceuticals
4 days ago
On-site
Nevada, United States
Market Access
General Summary:
- Field-based Field Reimbursement Manager (Kidney Patient Support Program, KPSP) serving as local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education, troubleshooting for timely patient access, and territory-level payer expertise.
Key Duties and Responsibilities:
- Compliantly build relationships with key nephrology office personnel involved in prior authorizations and specialty medication 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; follow up on case status and insurance documentation requirements.
- Maintain understanding of commercial and government prescription insurance coverage requirements, payer trends.
- Conduct on-site/virtual in-services and training on payer policies/formulary updates, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation, distribution pathways, hub services, enrollment, and reimbursement workflows.
- Manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand; develop territory engagement plans.
- Adhere to strict non-promotional guidelines and maintain patient PHI confidentiality; apply program business rules.
Knowledge and Skills:
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCP offices.
- Navigate payer portals, CRM systems, and field access tools; strong communication/training/relationship skills; analytics and data/reporting capability.
- Strategic account planning; judgment/problem-solving; travel 50–70%.
- Proficient Microsoft Office and Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education and Experience:
- Bachelor’s degree (health care, life sciences, or business); advanced degree preferred.
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep knowledge of benefits investigations, PA processes/appeals/coverage policies; payer knowledge including Medicare, Medicaid, and commercial.
Pay Range:
- $136,000 - $204,000
Application Instructions:
- N/A (not explicitly provided).
- Field-based Field Reimbursement Manager (Kidney Patient Support Program, KPSP) serving as local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education, troubleshooting for timely patient access, and territory-level payer expertise.
Key Duties and Responsibilities:
- Compliantly build relationships with key nephrology office personnel involved in prior authorizations and specialty medication 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; follow up on case status and insurance documentation requirements.
- Maintain understanding of commercial and government prescription insurance coverage requirements, payer trends.
- Conduct on-site/virtual in-services and training on payer policies/formulary updates, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation, distribution pathways, hub services, enrollment, and reimbursement workflows.
- Manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand; develop territory engagement plans.
- Adhere to strict non-promotional guidelines and maintain patient PHI confidentiality; apply program business rules.
Knowledge and Skills:
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCP offices.
- Navigate payer portals, CRM systems, and field access tools; strong communication/training/relationship skills; analytics and data/reporting capability.
- Strategic account planning; judgment/problem-solving; travel 50–70%.
- Proficient Microsoft Office and Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education and Experience:
- Bachelor’s degree (health care, life sciences, or business); advanced degree preferred.
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep knowledge of benefits investigations, PA processes/appeals/coverage policies; payer knowledge including Medicare, Medicaid, and commercial.
Pay Range:
- $136,000 - $204,000
Application Instructions:
- N/A (not explicitly provided).