Field Reimbursement Manager - Kidney (New England - ME, VT, NH, MA, RI, CT)
Vertex Pharmaceuticals
4 days ago
On-site
New Hampshire, United States
Market Access
Key Duties And Responsibilities:
- Establish compliant relationships with nephrology office staff to support prior authorizations and patient access to specialty medications.
- Partner with case management to resolve escalated access issues; use CRM triggers/workflows for coordinated handoffs.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways to enable timely patient access.
- Follow up on case status and ensure offices understand required insurance documentation.
- Maintain knowledge of commercial and government prescription insurance coverage and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, formulary/coverage nuances, PA/medical exception criteria, ICD-10/CPT coding & documentation, and hub/distribution/reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts by patient need, payer dynamics, and KPSP demand.
- Adhere to strict non-promotional and compliance/privacy guidelines; maintain confidentiality of patient health information.
Knowledge, Skills, and Requirements:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management experience with HCP offices; ability to navigate payer portals, CRM systems, and field access tools.
- Strong communication/training/relationship building; analytical skills; data/reporting fluency.
- Strategic business/account planning; sound judgment.
- Travel 50–70%; proficiency with Microsoft Outlook/Word/Excel/PowerPoint and Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
- Bachelor’s degree (health care/life sciences/business) or advanced degree preferred.
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles; deep knowledge of PA, appeals, coverage policies; payer knowledge (Medicare/Medicaid/commercial).
Pay/Benefits:
- $136,000–$204,000 base; eligible for annual bonus and annual equity.
- Benefits include medical/dental/vision, paid time off (incl. week-long shutdown in Summer and Winter), educational assistance/student loan repayment, commuting subsidy, matching charitable donations, and 401(k).
- Establish compliant relationships with nephrology office staff to support prior authorizations and patient access to specialty medications.
- Partner with case management to resolve escalated access issues; use CRM triggers/workflows for coordinated handoffs.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways to enable timely patient access.
- Follow up on case status and ensure offices understand required insurance documentation.
- Maintain knowledge of commercial and government prescription insurance coverage and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, formulary/coverage nuances, PA/medical exception criteria, ICD-10/CPT coding & documentation, and hub/distribution/reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts by patient need, payer dynamics, and KPSP demand.
- Adhere to strict non-promotional and compliance/privacy guidelines; maintain confidentiality of patient health information.
Knowledge, Skills, and Requirements:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management experience with HCP offices; ability to navigate payer portals, CRM systems, and field access tools.
- Strong communication/training/relationship building; analytical skills; data/reporting fluency.
- Strategic business/account planning; sound judgment.
- Travel 50–70%; proficiency with Microsoft Outlook/Word/Excel/PowerPoint and Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
- Bachelor’s degree (health care/life sciences/business) or advanced degree preferred.
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles; deep knowledge of PA, appeals, coverage policies; payer knowledge (Medicare/Medicaid/commercial).
Pay/Benefits:
- $136,000–$204,000 base; eligible for annual bonus and annual equity.
- Benefits include medical/dental/vision, paid time off (incl. week-long shutdown in Summer and Winter), educational assistance/student loan repayment, commuting subsidy, matching charitable donations, and 401(k).