Field Reimbursement Manager - Kidney (Michigan-North Ohio)
Vertex Pharmaceuticals
4 days ago
On-site
Ohio, United States
Market Access
General Summary:
- Field-based role supporting nephrology practices with non-promotional access and reimbursement education for Vertex kidney therapies; troubleshoot and apply territory-level payer expertise to ensure timely patient access.
Key Duties And Responsibilities:
- Establish compliant connections with nephrology office personnel involved in prior authorizations and specialty medication access.
- Partner with case management to address escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways.
- Follow up on case status; ensure offices understand insurance documentation requirements.
- Maintain understanding of commercial and government prescription coverage requirements, including payer trends.
- Conduct on-site/virtual in-services and training on regional payer policies, formulary updates, PA/medical exception criteria, ICD-10/CPT coding, documentation, distribution/hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate geographic region; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans; adhere to non-promotional and compliance/privacy guardrails.
- Maintain patient health information confidentiality; apply program business rules for a consistent, compliant experience.
Knowledge And Skills:
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCP/office staff.
- Ability to navigate payer portals, CRM systems, and field access tools; strong communication/training/relationship building.
- Analytical and data/reporting skills; strategic account plan execution.
- Travel 50–70% within territory; Microsoft Office (Outlook/Word/Excel/PowerPoint) and Salesforce CRM proficiency.
- Valid driver’s license; meet health care representative credentialing requirements.
Education And Experience:
- Bachelor’s 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 roles.
- Deep knowledge of benefits investigations, PA, appeals, coverage policies, and payer ecosystems; Medicare/Medicaid/commercial plan expertise.
Pay Range:
- $136,000 - $204,000
Benefits (explicitly stated):
- Annual bonus and annual equity awards; potential overtime eligibility (per federal/state requirements); medical/dental/vision, paid time off, educational assistance (student loan repayment), commuting subsidy, matching charitable donations, 401(k).
Application Instructions:
- Contact Talent Acquisition at ApplicationAssistance@vrtx.com for hiring-process accommodations (if needed).
- Field-based role supporting nephrology practices with non-promotional access and reimbursement education for Vertex kidney therapies; troubleshoot and apply territory-level payer expertise to ensure timely patient access.
Key Duties And Responsibilities:
- Establish compliant connections with nephrology office personnel involved in prior authorizations and specialty medication access.
- Partner with case management to address escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways.
- Follow up on case status; ensure offices understand insurance documentation requirements.
- Maintain understanding of commercial and government prescription coverage requirements, including payer trends.
- Conduct on-site/virtual in-services and training on regional payer policies, formulary updates, PA/medical exception criteria, ICD-10/CPT coding, documentation, distribution/hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate geographic region; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans; adhere to non-promotional and compliance/privacy guardrails.
- Maintain patient health information confidentiality; apply program business rules for a consistent, compliant experience.
Knowledge And Skills:
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCP/office staff.
- Ability to navigate payer portals, CRM systems, and field access tools; strong communication/training/relationship building.
- Analytical and data/reporting skills; strategic account plan execution.
- Travel 50–70% within territory; Microsoft Office (Outlook/Word/Excel/PowerPoint) and Salesforce CRM proficiency.
- Valid driver’s license; meet health care representative credentialing requirements.
Education And Experience:
- Bachelor’s 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 roles.
- Deep knowledge of benefits investigations, PA, appeals, coverage policies, and payer ecosystems; Medicare/Medicaid/commercial plan expertise.
Pay Range:
- $136,000 - $204,000
Benefits (explicitly stated):
- Annual bonus and annual equity awards; potential overtime eligibility (per federal/state requirements); medical/dental/vision, paid time off, educational assistance (student loan repayment), commuting subsidy, matching charitable donations, 401(k).
Application Instructions:
- Contact Talent Acquisition at ApplicationAssistance@vrtx.com for hiring-process accommodations (if needed).