Field Reimbursement Manager - Kidney (New England - ME, VT, NH, MA, RI, CT)
Vertex Pharmaceuticals
4 days ago
On-site
Greater Hartford
Market Access
General Summary
- Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP), serving as local subject matter expert to nephrology practices. Provide non-promotional access and reimbursement education and troubleshoot to support timely patient access to prescribed Vertex kidney therapies.
Key Duties and Responsibilities
- Compliantly build relationships with nephrology care team and prior authorization/patient access staff.
- 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 and ensure understanding of insurance documentation requirements.
- Maintain knowledge of commercial and government prescription insurance coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, PA/medical exceptions, coding/billing (ICD-10, CPT), documentation, distribution pathways, hub services, enrollment, and reimbursement workflows.
- Independently manage a multi-state region; prioritize accounts by patient need, payer dynamics, and KPSP demand.
- Create territory engagement plans to reduce patient-specific access barriers; follow strict non-promotional guidelines.
- Maintain confidentiality of patient health information and comply with applicable laws/regulations and company policies.
Knowledge, Skills, Qualifications, Education
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles.
- Deep understanding of benefits investigations, PA processes/appeals, coverage policies, and payer ecosystems (Medicare/Medicaid/commercial).
- Experience with specialty biologics/rare disease therapies or complex pharmacy benefit products.
- Ability to navigate payer portals, CRM systems, and field access tools.
- Strong communication/training/relationship-building; analytical skills; data/reporting ability.
- Comfort in fast-paced, results-driven environment; experience executing strategic business/account plans.
- Travel 50–70%; valid driver’s license; Microsoft Office and Salesforce CRM proficiency; ability to meet healthcare representative credentialing requirements.
- Bachelor’s degree in health care/life sciences/business (advanced degree a plus).
Compensation/Benefits (if applicable to the posting)
- Pay range: $136,000–$204,000; eligible for annual bonus and annual equity awards.
Application instructions
- Contact Talent Acquisition at ApplicationAssistance@vrtx.com for application assistance.
- Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP), serving as local subject matter expert to nephrology practices. Provide non-promotional access and reimbursement education and troubleshoot to support timely patient access to prescribed Vertex kidney therapies.
Key Duties and Responsibilities
- Compliantly build relationships with nephrology care team and prior authorization/patient access staff.
- 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 and ensure understanding of insurance documentation requirements.
- Maintain knowledge of commercial and government prescription insurance coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, PA/medical exceptions, coding/billing (ICD-10, CPT), documentation, distribution pathways, hub services, enrollment, and reimbursement workflows.
- Independently manage a multi-state region; prioritize accounts by patient need, payer dynamics, and KPSP demand.
- Create territory engagement plans to reduce patient-specific access barriers; follow strict non-promotional guidelines.
- Maintain confidentiality of patient health information and comply with applicable laws/regulations and company policies.
Knowledge, Skills, Qualifications, Education
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles.
- Deep understanding of benefits investigations, PA processes/appeals, coverage policies, and payer ecosystems (Medicare/Medicaid/commercial).
- Experience with specialty biologics/rare disease therapies or complex pharmacy benefit products.
- Ability to navigate payer portals, CRM systems, and field access tools.
- Strong communication/training/relationship-building; analytical skills; data/reporting ability.
- Comfort in fast-paced, results-driven environment; experience executing strategic business/account plans.
- Travel 50–70%; valid driver’s license; Microsoft Office and Salesforce CRM proficiency; ability to meet healthcare representative credentialing requirements.
- Bachelor’s degree in health care/life sciences/business (advanced degree a plus).
Compensation/Benefits (if applicable to the posting)
- Pay range: $136,000–$204,000; eligible for annual bonus and annual equity awards.
Application instructions
- Contact Talent Acquisition at ApplicationAssistance@vrtx.com for application assistance.