Field Reimbursement Manager - Kidney (Great Plains - NV, UT, CO, NE, KS)
Vertex Pharmaceuticals
4 days ago
On-site
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 troubleshoot to support timely patient access to prescribed Vertex kidney therapies.
Key Duties And Responsibilities:
- Compliantly establish connections with nephrology office personnel to support patient access and prior authorization needs.
- Partner with case management to address escalated access issues; coordinate handoffs via CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways; provide timely follow-up on case status and documentation requirements.
- Maintain understanding of commercial and government insurance coverage requirements, access requirements, and payer trends.
- Conduct compliant on-site/virtual in-services and training on payer policies, formulary/coverage nuances, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation, distribution/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 and confidentiality requirements; apply program business rules to ensure consistent, compliant patient/customer experience.
Knowledge And Skills:
- Experience with specialty biologics/rare disease or complex pharmacy benefit products; account management with HCP offices.
- Ability to use payer portals, CRM systems, and field access tools; strong communication/training/relationship skills.
- Analytical and data/reporting skills; comfortable in fast-paced, results-driven environment.
- Ability to develop/execute strategic account plans; sound judgment/problem-solving.
- Travel 50–70%; proficiency in Microsoft Outlook/Word/Excel/PowerPoint and Salesforce CRM.
- Valid driver’s license and ability to meet safe driving and healthcare representative credentialing requirements.
Education And Experience:
- Bachelor’s degree in health care, life sciences, or 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, coverage policies, and payer ecosystems; knowledge of Medicare/Medicaid/commercial plans.
Pay Range:
- $136,000–$204,000.
Benefits (as stated):
- Annual bonus and annual equity awards; may include overtime eligibility. Total Rewards include medical/dental/vision benefits, paid time off (including summer and winter shutdowns), educational assistance/student loan repayment, commuting subsidy, matching charitable donations, and 401(k).
- 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 troubleshoot to support timely patient access to prescribed Vertex kidney therapies.
Key Duties And Responsibilities:
- Compliantly establish connections with nephrology office personnel to support patient access and prior authorization needs.
- Partner with case management to address escalated access issues; coordinate handoffs via CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways; provide timely follow-up on case status and documentation requirements.
- Maintain understanding of commercial and government insurance coverage requirements, access requirements, and payer trends.
- Conduct compliant on-site/virtual in-services and training on payer policies, formulary/coverage nuances, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation, distribution/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 and confidentiality requirements; apply program business rules to ensure consistent, compliant patient/customer experience.
Knowledge And Skills:
- Experience with specialty biologics/rare disease or complex pharmacy benefit products; account management with HCP offices.
- Ability to use payer portals, CRM systems, and field access tools; strong communication/training/relationship skills.
- Analytical and data/reporting skills; comfortable in fast-paced, results-driven environment.
- Ability to develop/execute strategic account plans; sound judgment/problem-solving.
- Travel 50–70%; proficiency in Microsoft Outlook/Word/Excel/PowerPoint and Salesforce CRM.
- Valid driver’s license and ability to meet safe driving and healthcare representative credentialing requirements.
Education And Experience:
- Bachelor’s degree in health care, life sciences, or 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, coverage policies, and payer ecosystems; knowledge of Medicare/Medicaid/commercial plans.
Pay Range:
- $136,000–$204,000.
Benefits (as stated):
- Annual bonus and annual equity awards; may include overtime eligibility. Total Rewards include medical/dental/vision benefits, paid time off (including summer and winter shutdowns), educational assistance/student loan repayment, commuting subsidy, matching charitable donations, and 401(k).