Field Reimbursement Manager - Kidney (Michigan-North Ohio)
Vertex Pharmaceuticals
4 days ago
On-site
Michigan, United States
Market Access
Key Duties And Responsibilities
- Compliantly establish connections with nephrology practice personnel (care team and administrative staff) involved in prior authorizations and specialty medication access.
- Partner with case management to address escalated access issues; ensure coordinated handoffs using CRM triggers and workflows.
- Support timely patient access by educating offices on copay, PAP, Bridge programs, and other affordability pathways.
- Provide follow-up on case status and ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government prescription insurance coverage requirements, access needs, and payer trends.
- Conduct on-site and virtual in-services/training on regional payer policies, formulary updates, coverage nuances, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation, distribution pathways, hub services, enrollment processes, and reimbursement workflows.
- Independently manage a multistate geographic region; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Adapt engagement to existing office workflows; develop territory engagement plans to minimize access barriers.
- Follow non-promotional guidelines; maintain confidentiality of patient health information and comply with applicable laws, regulations, and company policies.
Knowledge And Skills
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCPs/office staff; navigate payer portals and CRM/field tools.
- Strong communication, training, relationship-building, analytical, and data/reporting skills.
- Experience executing strategic business/account plans; sound judgment; travel 50–70%.
- Proficiency: Microsoft Outlook/Word/Excel/PowerPoint; Salesforce CRM.
- Valid driver’s license and ability to meet safe driving requirements; meet healthcare industry representative credentialing.
Education And Experience
- Bachelor’s degree in health care, life sciences, or business (advanced degree is a plus).
- 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, and payer ecosystems.
- Payer knowledge: Medicare, Medicaid, and commercial insurance plans.
Pay Range
- $136,000 - $204,000
- Compliantly establish connections with nephrology practice personnel (care team and administrative staff) involved in prior authorizations and specialty medication access.
- Partner with case management to address escalated access issues; ensure coordinated handoffs using CRM triggers and workflows.
- Support timely patient access by educating offices on copay, PAP, Bridge programs, and other affordability pathways.
- Provide follow-up on case status and ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government prescription insurance coverage requirements, access needs, and payer trends.
- Conduct on-site and virtual in-services/training on regional payer policies, formulary updates, coverage nuances, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation, distribution pathways, hub services, enrollment processes, and reimbursement workflows.
- Independently manage a multistate geographic region; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Adapt engagement to existing office workflows; develop territory engagement plans to minimize access barriers.
- Follow non-promotional guidelines; maintain confidentiality of patient health information and comply with applicable laws, regulations, and company policies.
Knowledge And Skills
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCPs/office staff; navigate payer portals and CRM/field tools.
- Strong communication, training, relationship-building, analytical, and data/reporting skills.
- Experience executing strategic business/account plans; sound judgment; travel 50–70%.
- Proficiency: Microsoft Outlook/Word/Excel/PowerPoint; Salesforce CRM.
- Valid driver’s license and ability to meet safe driving requirements; meet healthcare industry representative credentialing.
Education And Experience
- Bachelor’s degree in health care, life sciences, or business (advanced degree is a plus).
- 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, and payer ecosystems.
- Payer knowledge: Medicare, Medicaid, and commercial insurance plans.
Pay Range
- $136,000 - $204,000