Field Reimbursement Manager - Kidney (Midwest - ND, SD, WI, MN)
Vertex Pharmaceuticals
3 days ago
On-site
Minnesota, United States
Market Access
Key Duties And Responsibilities
- Establish compliant relationships with nephrology office care teams and administrative staff to support prior authorizations and patient access to specialty medications.
- Partner with case management to resolve escalated access issues; coordinate handoffs via CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways; provide timely follow-up on case status and documentation needs.
- Maintain knowledge of commercial and government insurance coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, formulary updates, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation, distribution pathways, hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Adhere to strict non-promotional guidelines and protect patient confidentiality; follow laws/regulations and program business rules.
Knowledge And Skills / Qualifications
- Specialty biologics/rare disease or complex pharmacy benefit experience.
- Account management and direct work with HCP offices on access challenges.
- Ability to navigate payer portals, CRM systems, and field access tools.
- Strong communication/training, relationship-building, analytical, and data/reporting skills; strategic account planning.
- Travel 50–70% within territory; valid driver’s license; meet healthcare representative credentialing requirements.
- Proficient in Microsoft Outlook/Word/Excel/PowerPoint and Salesforce CRM.
Education And Experience
- Bachelor’s degree (health care, life sciences, or business); advanced degree preferred.
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles.
- Deep understanding of benefits investigations, PA, appeals, and coverage policies; payer knowledge of Medicare/Medicaid/commercial.
Pay Range
- $136,000–$204,000
- Establish compliant relationships with nephrology office care teams and administrative staff to support prior authorizations and patient access to specialty medications.
- Partner with case management to resolve escalated access issues; coordinate handoffs via CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways; provide timely follow-up on case status and documentation needs.
- Maintain knowledge of commercial and government insurance coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, formulary updates, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation, distribution pathways, hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Adhere to strict non-promotional guidelines and protect patient confidentiality; follow laws/regulations and program business rules.
Knowledge And Skills / Qualifications
- Specialty biologics/rare disease or complex pharmacy benefit experience.
- Account management and direct work with HCP offices on access challenges.
- Ability to navigate payer portals, CRM systems, and field access tools.
- Strong communication/training, relationship-building, analytical, and data/reporting skills; strategic account planning.
- Travel 50–70% within territory; valid driver’s license; meet healthcare representative credentialing requirements.
- Proficient in Microsoft Outlook/Word/Excel/PowerPoint and Salesforce CRM.
Education And Experience
- Bachelor’s degree (health care, life sciences, or business); advanced degree preferred.
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles.
- Deep understanding of benefits investigations, PA, appeals, and coverage policies; payer knowledge of Medicare/Medicaid/commercial.
Pay Range
- $136,000–$204,000