Field Reimbursement Manager - Kidney (IN-KY-TN)
Vertex Pharmaceuticals
4 days ago
On-site
Kentucky, United States
Market Access
General Summary:
Field-based Field Reimbursement Manager (Kidney Patient Support Program, KPSP). Serve as local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education, troubleshooting to support timely patient access to prescribed Vertex kidney therapies.
Key Duties and Responsibilities:
- Build compliant relationships with nephrology office personnel involved in prior authorizations and patient access to specialty medications.
- Partner with case management to resolve escalated access issues; coordinate handoffs using CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways.
- Follow up on case status; 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 coding & documentation, distribution pathways, hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; develop territory engagement plans to reduce access barriers.
- Adhere to strict non-promotional and privacy/compliance guidelines; maintain confidentiality.
Knowledge and Skills:
- Experience with specialty biologics/rare disease/complex pharmacy benefit products; account management with HCPs.
- Ability to navigate payer portals/CRM and field access tools; strong training/relationship skills.
- Analytical skills using data/reporting tools to prioritize caseload; strategic account planning.
- Travel 50–70%; Microsoft Outlook/Word/Excel/PowerPoint/Salesforce.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education and Experience:
- Bachelor’s 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 processes, appeals, coverage policies; payer knowledge incl. Medicare/Medicaid/commercial.
Compensation/Benefits:
- Pay range: $136,000–$204,000. Eligible for annual bonus and annual equity; some roles may be eligible for overtime. Total Rewards benefits include medical/dental/vision, paid time off, educational assistance/student loan repayment, commuting subsidy, charitable matching, and 401(k).
Application Instructions:
- For application process accommodations: ApplicationAssistance@vrtx.com.
Field-based Field Reimbursement Manager (Kidney Patient Support Program, KPSP). Serve as local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education, troubleshooting to support timely patient access to prescribed Vertex kidney therapies.
Key Duties and Responsibilities:
- Build compliant relationships with nephrology office personnel involved in prior authorizations and patient access to specialty medications.
- Partner with case management to resolve escalated access issues; coordinate handoffs using CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways.
- Follow up on case status; 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 coding & documentation, distribution pathways, hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; develop territory engagement plans to reduce access barriers.
- Adhere to strict non-promotional and privacy/compliance guidelines; maintain confidentiality.
Knowledge and Skills:
- Experience with specialty biologics/rare disease/complex pharmacy benefit products; account management with HCPs.
- Ability to navigate payer portals/CRM and field access tools; strong training/relationship skills.
- Analytical skills using data/reporting tools to prioritize caseload; strategic account planning.
- Travel 50–70%; Microsoft Outlook/Word/Excel/PowerPoint/Salesforce.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education and Experience:
- Bachelor’s 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 processes, appeals, coverage policies; payer knowledge incl. Medicare/Medicaid/commercial.
Compensation/Benefits:
- Pay range: $136,000–$204,000. Eligible for annual bonus and annual equity; some roles may be eligible for overtime. Total Rewards benefits include medical/dental/vision, paid time off, educational assistance/student loan repayment, commuting subsidy, charitable matching, and 401(k).
Application Instructions:
- For application process accommodations: ApplicationAssistance@vrtx.com.