Field Reimbursement Manager - Kidney (New England - ME, VT, NH, MA, RI, CT)
Vertex Pharmaceuticals
3 months ago
On-site
Maine, United States
Market Access
General Summary:
Field-based role as a Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP), serving as a local subject matter expert to nephrology practices with non-promotional access and reimbursement education. Provide timely patient access for prescribed Vertex kidney therapies through troubleshooting and payer expertise.
Key Duties And Responsibilities:
- Compliantly connect with nephrology office personnel to support patient access (including prior authorizations and specialty medication 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 prescription coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, formulary updates, coverage nuances; PA/medical exception criteria; coding/billing (ICD-10, CPT); distribution pathways, hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize patient access barriers.
- Adhere to non-promotional and compliance/privacy guardrails; maintain confidentiality of patient health information.
- Apply program business rules/work instructions for a consistent, compliant patient/customer experience.
Knowledge And Skills / Qualifications:
- Experience with specialty biologics/rare disease therapies or complex pharmacy benefit products.
- Account management with HCP office staff to navigate access challenges.
- Navigate payer portals, CRM systems, and field access tools.
- Strong communication/training/relationship-building; analytical and data/reporting skills.
- Strategic account/business plan experience; sound judgment.
- Travel 50–70%.
- Proficient: Outlook, Word, Excel, PowerPoint, Salesforce CRM.
- Valid driver’s license; meet health care representative credentialing requirements.
Education And Experience:
- Bachelor’s degree in health care, life sciences, or business (advanced degree a plus).
- Minimum 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.
- Payer knowledge of Medicare, Medicaid, and commercial insurance.
Pay Range (if applicable):
$136,000 - $204,000
Field-based role as a Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP), serving as a local subject matter expert to nephrology practices with non-promotional access and reimbursement education. Provide timely patient access for prescribed Vertex kidney therapies through troubleshooting and payer expertise.
Key Duties And Responsibilities:
- Compliantly connect with nephrology office personnel to support patient access (including prior authorizations and specialty medication 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 prescription coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, formulary updates, coverage nuances; PA/medical exception criteria; coding/billing (ICD-10, CPT); distribution pathways, hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize patient access barriers.
- Adhere to non-promotional and compliance/privacy guardrails; maintain confidentiality of patient health information.
- Apply program business rules/work instructions for a consistent, compliant patient/customer experience.
Knowledge And Skills / Qualifications:
- Experience with specialty biologics/rare disease therapies or complex pharmacy benefit products.
- Account management with HCP office staff to navigate access challenges.
- Navigate payer portals, CRM systems, and field access tools.
- Strong communication/training/relationship-building; analytical and data/reporting skills.
- Strategic account/business plan experience; sound judgment.
- Travel 50–70%.
- Proficient: Outlook, Word, Excel, PowerPoint, Salesforce CRM.
- Valid driver’s license; meet health care representative credentialing requirements.
Education And Experience:
- Bachelor’s degree in health care, life sciences, or business (advanced degree a plus).
- Minimum 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.
- Payer knowledge of Medicare, Medicaid, and commercial insurance.
Pay Range (if applicable):
$136,000 - $204,000