Field Reimbursement Manager - Kidney (IN-KY-TN)
Vertex Pharmaceuticals
9 days ago
On-site
United States
Market Access
General Summary:
- Field-based Field Reimbursement Manager role supporting Vertex Kidney Patient Support Program (KPSP) by serving 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 therapies.
Key Duties and Responsibilities:
- Build compliant relationships with nephrology office personnel involved in prior authorizations and specialty medication access.
- Partner with case management to address escalated access issues and coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways.
- Follow up on case status and ensure understanding of insurance documentation requirements.
- Maintain understanding of commercial and government prescription insurance coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on regional payer policies, formulary updates, coverage nuances, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation requirements, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize patient-specific access barriers; adhere to non-promotional guidelines and comply with legal/compliance/privacy guardrails.
- Maintain confidentiality of patient health information; apply program business rules and work instructions.
Knowledge and Skills (Required/Preferred):
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCPs and office staff; payer portal/CRM and field access tools.
- Strong communication, training, relationship-building, and analytical skills; ability to use data/reporting tools to manage caseload.
- Strategic business/account planning experience; sound judgment in decision-making.
- Travel 50–70%; MS Outlook/Word/Excel/PowerPoint/Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
- Bachelor’s degree (health care/life sciences/business); 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles.
- Deep understanding of benefits investigations, PA processes, appeals, coverage policies; strong Medicare/Medicaid/commercial insurance knowledge.
Pay Range:
- $136,000 - $204,000
Benefits (as stated):
- Annual bonus and annual equity awards; may be eligible for overtime pay.
- Medical/dental/vision, paid time off (including summer/winter shutdown), educational assistance/student loan repayment, commuting subsidy, matching charitable donations, 401(k).
Application Instructions:
- Apply via the process described by Vertex; for application accommodation, contact ApplicationAssistance@vrtx.com.
- Field-based Field Reimbursement Manager role supporting Vertex Kidney Patient Support Program (KPSP) by serving 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 therapies.
Key Duties and Responsibilities:
- Build compliant relationships with nephrology office personnel involved in prior authorizations and specialty medication access.
- Partner with case management to address escalated access issues and coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways.
- Follow up on case status and ensure understanding of insurance documentation requirements.
- Maintain understanding of commercial and government prescription insurance coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on regional payer policies, formulary updates, coverage nuances, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation requirements, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize patient-specific access barriers; adhere to non-promotional guidelines and comply with legal/compliance/privacy guardrails.
- Maintain confidentiality of patient health information; apply program business rules and work instructions.
Knowledge and Skills (Required/Preferred):
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCPs and office staff; payer portal/CRM and field access tools.
- Strong communication, training, relationship-building, and analytical skills; ability to use data/reporting tools to manage caseload.
- Strategic business/account planning experience; sound judgment in decision-making.
- Travel 50–70%; MS Outlook/Word/Excel/PowerPoint/Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
- Bachelor’s degree (health care/life sciences/business); 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles.
- Deep understanding of benefits investigations, PA processes, appeals, coverage policies; strong Medicare/Medicaid/commercial insurance knowledge.
Pay Range:
- $136,000 - $204,000
Benefits (as stated):
- Annual bonus and annual equity awards; may be eligible for overtime pay.
- Medical/dental/vision, paid time off (including summer/winter shutdown), educational assistance/student loan repayment, commuting subsidy, matching charitable donations, 401(k).
Application Instructions:
- Apply via the process described by Vertex; for application accommodation, contact ApplicationAssistance@vrtx.com.