Field Reimbursement Manager - Kidney (Midwest - ND, SD, WI, MN)
Vertex Pharmaceuticals
4 days ago
On-site
South Dakota, United States
Market Access
General Summary:
Field-based Field Reimbursement Manager for Vertex Kidney Patient Support Program (KPSP), serving as a non-promotional access and reimbursement education subject matter expert to nephrology practices; troubleshoot to support timely patient access to prescribed kidney therapies.
Key Duties and Responsibilities:
- Compliantly build relationships with nephrology office care team and prior authorization/patient access staff to support patient 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 knowledge of commercial and government coverage requirements, access needs, and payer trends.
- Deliver compliant on-site/virtual in-services and training on payer policies, formulary updates, PA/medical exception criteria, ICD-10/CPT/documentation, and reimbursement workflows.
- Manage a multistate territory independently; develop territory engagement plans to reduce access barriers.
- Adhere to non-promotional guidelines; maintain patient HIPAA/confidentiality and comply with laws and policies.
Knowledge and Skills / Qualifications:
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles.
- Experience with specialty biologics/rare disease therapies and complex pharmacy benefit products.
- Deep understanding of benefits investigations, PA processes, appeals, coverage policies, and Medicare/Medicaid/commercial payers.
- Ability to navigate payer portals and CRM; strong training/relationship-building and analytical/reporting skills.
- Bachelor’s degree (health care/life sciences/business); advanced degree a plus.
- Travel 50–70%; valid driver’s license; credentialing to enter facilities.
Pay Range:
$136,000–$204,000; eligible for annual bonus and annual equity awards.
Field-based Field Reimbursement Manager for Vertex Kidney Patient Support Program (KPSP), serving as a non-promotional access and reimbursement education subject matter expert to nephrology practices; troubleshoot to support timely patient access to prescribed kidney therapies.
Key Duties and Responsibilities:
- Compliantly build relationships with nephrology office care team and prior authorization/patient access staff to support patient 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 knowledge of commercial and government coverage requirements, access needs, and payer trends.
- Deliver compliant on-site/virtual in-services and training on payer policies, formulary updates, PA/medical exception criteria, ICD-10/CPT/documentation, and reimbursement workflows.
- Manage a multistate territory independently; develop territory engagement plans to reduce access barriers.
- Adhere to non-promotional guidelines; maintain patient HIPAA/confidentiality and comply with laws and policies.
Knowledge and Skills / Qualifications:
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles.
- Experience with specialty biologics/rare disease therapies and complex pharmacy benefit products.
- Deep understanding of benefits investigations, PA processes, appeals, coverage policies, and Medicare/Medicaid/commercial payers.
- Ability to navigate payer portals and CRM; strong training/relationship-building and analytical/reporting skills.
- Bachelor’s degree (health care/life sciences/business); advanced degree a plus.
- Travel 50–70%; valid driver’s license; credentialing to enter facilities.
Pay Range:
$136,000–$204,000; eligible for annual bonus and annual equity awards.