Field Reimbursement Manager - Kidney (New England - ME, VT, NH, MA, RI, CT)
Vertex Pharmaceuticals
3 days ago
On-site
Greater Burlington Area
Market Access
General Summary:
- Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP). Serve as local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education, and support timely patient access through troubleshooting and payer expertise.
Key Duties and Responsibilities:
- Establish compliant connections with nephrology office personnel involved in prior authorizations and patient access.
- Partner with case management to address escalated access issues and ensure coordinated handoffs via CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways to support timely access.
- Follow up on case status and ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government insurance coverage requirements and payer trends.
- Conduct compliant 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 processes, and reimbursement workflows.
- Manage a multistate territory, prioritizing accounts by patient need, payer dynamics, and KPSP demand; adapt engagement to office workflows.
- Develop territory engagement plans to minimize patient-specific access barriers.
- Adhere to strict non-promotional guidelines; comply with legal/compliance/privacy guardrails; maintain confidentiality of patient health information.
Knowledge, Skills, and Qualifications:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCPs and office staff; ability to navigate payer portals, CRM, and field access tools.
- Strong communication/training/relationship-building and analytical/data/reporting skills.
- Experience developing and executing strategic business/account plans; good judgment/problem solving.
- Travel 50–70% within territory; proficiency in Microsoft Outlook/Word/Excel/PowerPoint and Salesforce CRM.
- Valid driver’s license; meet healthcare industry credentialing requirements.
Education and Experience:
- Bachelor’s degree in healthcare, life sciences, or business (advanced degree a plus).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles.
- Deep understanding of benefits investigations, PA processes, appeals, and coverage policies; payer knowledge including Medicare, Medicaid, and commercial plans.
Pay Range:
- $136,000 - $204,000
Benefits (explicitly stated):
- Annual bonus; annual equity awards; possible overtime (per requirements); medical/dental/vision benefits; paid time off (incl. week-long summer and winter shutdown); educational assistance (incl. student loan repayment); commuting subsidy; matching charitable donations; 401(k).
- Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP). Serve as local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education, and support timely patient access through troubleshooting and payer expertise.
Key Duties and Responsibilities:
- Establish compliant connections with nephrology office personnel involved in prior authorizations and patient access.
- Partner with case management to address escalated access issues and ensure coordinated handoffs via CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways to support timely access.
- Follow up on case status and ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government insurance coverage requirements and payer trends.
- Conduct compliant 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 processes, and reimbursement workflows.
- Manage a multistate territory, prioritizing accounts by patient need, payer dynamics, and KPSP demand; adapt engagement to office workflows.
- Develop territory engagement plans to minimize patient-specific access barriers.
- Adhere to strict non-promotional guidelines; comply with legal/compliance/privacy guardrails; maintain confidentiality of patient health information.
Knowledge, Skills, and Qualifications:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCPs and office staff; ability to navigate payer portals, CRM, and field access tools.
- Strong communication/training/relationship-building and analytical/data/reporting skills.
- Experience developing and executing strategic business/account plans; good judgment/problem solving.
- Travel 50–70% within territory; proficiency in Microsoft Outlook/Word/Excel/PowerPoint and Salesforce CRM.
- Valid driver’s license; meet healthcare industry credentialing requirements.
Education and Experience:
- Bachelor’s degree in healthcare, life sciences, or business (advanced degree a plus).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles.
- Deep understanding of benefits investigations, PA processes, appeals, and coverage policies; payer knowledge including Medicare, Medicaid, and commercial plans.
Pay Range:
- $136,000 - $204,000
Benefits (explicitly stated):
- Annual bonus; annual equity awards; possible overtime (per requirements); medical/dental/vision benefits; paid time off (incl. week-long summer and winter shutdown); educational assistance (incl. student loan repayment); commuting subsidy; matching charitable donations; 401(k).