Field Reimbursement Manager - Kidney (Midwest - ND, SD, WI, MN)
Vertex Pharmaceuticals
3 days ago
On-site
Wisconsin, United States
Market Access
General Summary
Field-based Field Reimbursement Manager for Vertex Kidney Patient Support Program (KPSP). Serve as local subject-matter expert to nephrology practices, providing non-promotional access and reimbursement education; troubleshoot to support timely patient access to prescribed Vertex kidney therapies.
Key Duties and Responsibilities
- Build compliant relationships with nephrology office personnel supporting prior authorizations and patient access to specialty medications.
- Partner with case management to resolve escalated access issues; coordinate handoffs via 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 knowledge of commercial and government prescription insurance requirements, coverage, and payer trends.
- Deliver compliant on-site/virtual in-services and training covering payer policies/formulary updates, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation, distribution/hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate region; prioritize accounts based on patient need and payer dynamics.
- Develop territory engagement plans to minimize patient-specific access barriers; follow strict non-promotional and legal/compliance/privacy guidelines.
- Maintain patient confidentiality; apply program business rules to ensure consistent, compliant patient/customer experience.
Qualifications & Skills
- Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCPs/office staff.
- Proficiency navigating payer portals, CRM systems, and field access tools; strong training/relationship-building, analytical, and data/reporting skills.
- Travel 50–70%; MS Outlook/Word/Excel/PowerPoint/Salesforce.
Education & Experience
- BS in healthcare/life sciences/business (advanced degree preferred).
- 5+ years in sales/reimbursement/market access/specialty pharmacy/patient services/field access roles.
- Deep understanding of benefits investigations, PA, appeals, coverage policies, and Medicare/Medicaid/commercial.
Benefits / Pay
- Pay range: $136,000–$204,000. Eligible for annual bonus and annual equity awards; possible overtime. Total Rewards include medical/dental/vision, paid time off, education assistance (e.g., student loan repayment), commuting subsidy, charitable matching, and 401(k).
Field-based Field Reimbursement Manager for Vertex Kidney Patient Support Program (KPSP). Serve as local subject-matter expert to nephrology practices, providing non-promotional access and reimbursement education; troubleshoot to support timely patient access to prescribed Vertex kidney therapies.
Key Duties and Responsibilities
- Build compliant relationships with nephrology office personnel supporting prior authorizations and patient access to specialty medications.
- Partner with case management to resolve escalated access issues; coordinate handoffs via 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 knowledge of commercial and government prescription insurance requirements, coverage, and payer trends.
- Deliver compliant on-site/virtual in-services and training covering payer policies/formulary updates, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation, distribution/hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate region; prioritize accounts based on patient need and payer dynamics.
- Develop territory engagement plans to minimize patient-specific access barriers; follow strict non-promotional and legal/compliance/privacy guidelines.
- Maintain patient confidentiality; apply program business rules to ensure consistent, compliant patient/customer experience.
Qualifications & Skills
- Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCPs/office staff.
- Proficiency navigating payer portals, CRM systems, and field access tools; strong training/relationship-building, analytical, and data/reporting skills.
- Travel 50–70%; MS Outlook/Word/Excel/PowerPoint/Salesforce.
Education & Experience
- BS in healthcare/life sciences/business (advanced degree preferred).
- 5+ years in sales/reimbursement/market access/specialty pharmacy/patient services/field access roles.
- Deep understanding of benefits investigations, PA, appeals, coverage policies, and Medicare/Medicaid/commercial.
Benefits / Pay
- Pay range: $136,000–$204,000. Eligible for annual bonus and annual equity awards; possible overtime. Total Rewards include medical/dental/vision, paid time off, education assistance (e.g., student loan repayment), commuting subsidy, charitable matching, and 401(k).