Field Reimbursement Manager - Kidney (Midwest - ND, SD, WI, MN)
Vertex Pharmaceuticals
4 days ago
On-site
North Dakota, United States
Market Access
General Summary:
Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP), serving as local subject matter expert to nephrology practices to provide non-promotional access and reimbursement education; troubleshoot to support timely patient access to prescribed kidney therapies.
Key Duties And Responsibilities:
- Build compliant relationships with nephrology care and authorization/access personnel to support patient access.
- Partner with case management to resolve escalated access issues; coordinate handoffs via CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways; ensure offices follow insurance documentation requirements.
- Maintain knowledge of commercial and government prescription insurance coverage requirements and payer trends.
- Conduct compliant on-site/virtual in-services and training on payer policies, formulary updates, coverage nuances, PA/medical exceptions, ICD-10/CPT, distribution pathways, hub services, enrollment, and reimbursement workflows.
- Manage a multistate territory independently; prioritize accounts and develop territory engagement plans; adapt to office workflows.
- Follow strict non-promotional, privacy, and compliance guidelines.
Knowledge And Skills:
Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCP offices; navigation of payer portals/CRM/tools; strong communication/training/relationship skills; analytical and data/reporting skills; ability to work in a fast-paced environment; strategic business/account planning; judgment in problem-solving; travel 50–70%; Microsoft Office and Salesforce CRM; valid driver’s license; ability to meet facility credentialing.
Education And Experience:
- Bachelor’s degree (health care/life sciences/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 Medicare/Medicaid/commercial plans.
Pay Range: $136,000 - $204,000
Benefits (as stated): annual bonus, annual equity awards; inclusive medical/dental/vision, paid time off, educational assistance/student loan repayment, commuting subsidy, matching charitable donations, 401(k).
Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP), serving as local subject matter expert to nephrology practices to provide non-promotional access and reimbursement education; troubleshoot to support timely patient access to prescribed kidney therapies.
Key Duties And Responsibilities:
- Build compliant relationships with nephrology care and authorization/access personnel to support patient access.
- Partner with case management to resolve escalated access issues; coordinate handoffs via CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways; ensure offices follow insurance documentation requirements.
- Maintain knowledge of commercial and government prescription insurance coverage requirements and payer trends.
- Conduct compliant on-site/virtual in-services and training on payer policies, formulary updates, coverage nuances, PA/medical exceptions, ICD-10/CPT, distribution pathways, hub services, enrollment, and reimbursement workflows.
- Manage a multistate territory independently; prioritize accounts and develop territory engagement plans; adapt to office workflows.
- Follow strict non-promotional, privacy, and compliance guidelines.
Knowledge And Skills:
Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCP offices; navigation of payer portals/CRM/tools; strong communication/training/relationship skills; analytical and data/reporting skills; ability to work in a fast-paced environment; strategic business/account planning; judgment in problem-solving; travel 50–70%; Microsoft Office and Salesforce CRM; valid driver’s license; ability to meet facility credentialing.
Education And Experience:
- Bachelor’s degree (health care/life sciences/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 Medicare/Medicaid/commercial plans.
Pay Range: $136,000 - $204,000
Benefits (as stated): annual bonus, annual equity awards; inclusive medical/dental/vision, paid time off, educational assistance/student loan repayment, commuting subsidy, matching charitable donations, 401(k).