Field Reimbursement Manager - Kidney (New England - ME, VT, NH, MA, RI, CT)
Vertex Pharmaceuticals
4 days ago
On-site
Massachusetts, United States
Market Access
Key Duties and Responsibilities:
- Build compliant connections with nephrology office personnel (care team and staff handling prior authorizations/patient access).
- Partner with case management to resolve escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Support timely patient access by educating offices on copay, PAP, Bridge programs, and other affordability pathways.
- Follow up on case status and ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government insurance coverage requirements, access needs, and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, formulary updates, coverage nuances, PA/medical exception criteria, ICD-10/CPT coding, documentation, and distribution/hub/reimbursement workflows.
- Independently manage a multistate territory (prioritize accounts by patient need, payer dynamics, and KPSP demand).
- Develop territory engagement plans to minimize access barriers; avoid inefficiencies.
- Follow strict non-promotional and all compliance/privacy/confidentiality requirements; apply program business rules.
Knowledge and Skills/Qualifications:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCP offices for complex access challenges.
- Ability to navigate payer portals, CRM systems, and field access tools.
- Strong communication, training, relationship-building, analytical, and data/reporting skills.
- Ability to develop strategic account plans and exercise sound judgment.
- Travel 50–70%.
- Proficiency: Outlook, Word, Excel, PowerPoint, Salesforce CRM.
- Valid driver’s license; ability to meet credentialing requirements.
Education and Experience:
- Bachelor’s degree (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.
- Deep understanding of benefits investigations, PA processes/appeals, coverage policies, and payer ecosystems; knowledge of Medicare, Medicaid, and commercial plans.
Pay/Benefits (as stated):
- $136,000–$204,000; eligible for annual bonus and equity.
- Total Rewards include medical/dental/vision, paid time off (incl. summer/winter shutdown), educational assistance, commuting subsidy, matching charitable donations, and 401(k).
- Build compliant connections with nephrology office personnel (care team and staff handling prior authorizations/patient access).
- Partner with case management to resolve escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Support timely patient access by educating offices on copay, PAP, Bridge programs, and other affordability pathways.
- Follow up on case status and ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government insurance coverage requirements, access needs, and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, formulary updates, coverage nuances, PA/medical exception criteria, ICD-10/CPT coding, documentation, and distribution/hub/reimbursement workflows.
- Independently manage a multistate territory (prioritize accounts by patient need, payer dynamics, and KPSP demand).
- Develop territory engagement plans to minimize access barriers; avoid inefficiencies.
- Follow strict non-promotional and all compliance/privacy/confidentiality requirements; apply program business rules.
Knowledge and Skills/Qualifications:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCP offices for complex access challenges.
- Ability to navigate payer portals, CRM systems, and field access tools.
- Strong communication, training, relationship-building, analytical, and data/reporting skills.
- Ability to develop strategic account plans and exercise sound judgment.
- Travel 50–70%.
- Proficiency: Outlook, Word, Excel, PowerPoint, Salesforce CRM.
- Valid driver’s license; ability to meet credentialing requirements.
Education and Experience:
- Bachelor’s degree (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.
- Deep understanding of benefits investigations, PA processes/appeals, coverage policies, and payer ecosystems; knowledge of Medicare, Medicaid, and commercial plans.
Pay/Benefits (as stated):
- $136,000–$204,000; eligible for annual bonus and equity.
- Total Rewards include medical/dental/vision, paid time off (incl. summer/winter shutdown), educational assistance, commuting subsidy, matching charitable donations, and 401(k).