Field Reimbursement Manager - Kidney (Great Plains - NV, UT, CO, NE, KS)
Vertex Pharmaceuticals
3 months ago
On-site
Nebraska, 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 reimbursement/access education and troubleshooting to support timely patient access to Vertex kidney therapies.
Key Duties and Responsibilities
- Build compliant relationships with nephrology office care teams and prior authorization/patient access staff.
- Coordinate with case management on escalated access issues using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways; follow up on case status and insurance documentation needs.
- Maintain knowledge of commercial and government insurance coverage and payer trends.
- Deliver compliant on-site/virtual in-services and training covering payer policies/formulary updates, PA/medical exception criteria, ICD-10/CPT coding, documentation, and reimbursement/hub enrollment workflows.
- Independently manage a multistate territory; develop territory engagement plans to minimize access barriers; adapt to existing office workflows.
- Follow non-promotional, confidentiality, legal/regulatory, and program business rules.
Knowledge and Skills
- Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCP offices.
- Navigate payer portals/CRM; strong communication, training, relationship-building, analytical, and data/reporting skills.
- Strategic planning/problem-solving judgment; travel 50–70%; proficiency in Outlook/Word/Excel/PowerPoint/Salesforce.
- Valid driver’s license; meet health care representative credentialing requirements.
Education and Experience
- BS in health care/life sciences/business (advanced degree a plus).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field access roles.
- Deep understanding of benefits investigations, PA/appeals, coverage policies; Medicare/Medicaid/commercial payer knowledge.
Pay Range
- $136,000–$204,000; eligible for annual bonus and annual equity awards.
- Field-based Field Reimbursement Manager for Vertex Kidney Patient Support Program (KPSP). Serve as local subject matter expert to nephrology practices, providing non-promotional reimbursement/access education and troubleshooting to support timely patient access to Vertex kidney therapies.
Key Duties and Responsibilities
- Build compliant relationships with nephrology office care teams and prior authorization/patient access staff.
- Coordinate with case management on escalated access issues using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways; follow up on case status and insurance documentation needs.
- Maintain knowledge of commercial and government insurance coverage and payer trends.
- Deliver compliant on-site/virtual in-services and training covering payer policies/formulary updates, PA/medical exception criteria, ICD-10/CPT coding, documentation, and reimbursement/hub enrollment workflows.
- Independently manage a multistate territory; develop territory engagement plans to minimize access barriers; adapt to existing office workflows.
- Follow non-promotional, confidentiality, legal/regulatory, and program business rules.
Knowledge and Skills
- Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCP offices.
- Navigate payer portals/CRM; strong communication, training, relationship-building, analytical, and data/reporting skills.
- Strategic planning/problem-solving judgment; travel 50–70%; proficiency in Outlook/Word/Excel/PowerPoint/Salesforce.
- Valid driver’s license; meet health care representative credentialing requirements.
Education and Experience
- BS in health care/life sciences/business (advanced degree a plus).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field access roles.
- Deep understanding of benefits investigations, PA/appeals, coverage policies; Medicare/Medicaid/commercial payer knowledge.
Pay Range
- $136,000–$204,000; eligible for annual bonus and annual equity awards.