Field Reimbursement Manager - Kidney (NJ-MD-DE)
Vertex Pharmaceuticals
4 days ago
On-site
New Jersey, United States
Market Access
General Summary:
- Field-based Field Reimbursement Manager for Vertex Kidney Patient Support Program (KPSP), serving as local subject matter expert to nephrology practices. Provide non-promotional access and reimbursement education and support timely patient access to prescribed Vertex kidney therapies.
Key Duties and Responsibilities:
- Build compliant connections with nephrology office care and administrative staff involved in prior authorizations and patient access.
- Partner with case management to address escalated access issues; coordinate handoffs using CRM triggers and 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 understanding of commercial and government prescription insurance coverage requirements, access needs, and payer trends.
- Conduct compliant on-site/virtual in-services and training on payer policies, formulary updates, coverage nuances; PA/medical exceptions; coding/billing (ICD-10, CPT) and documentation; distribution pathways/hub services/enrollment/reimbursement workflows.
- Independently manage a multi-state region; adapt engagement to office workflows; develop territory engagement plans.
- Adhere to strict non-promotional guidelines; maintain confidentiality of patient health information and comply with laws/regulations/company policies; apply program business rules.
Knowledge and Skills:
- Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCP/office staff.
- Payer portal/CRM/tool navigation; strong communication/training/relationship skills.
- Analytical/data skills for caseload management and prioritization.
- Strategic business/account planning; sound judgment; travel 50–70%.
- Proficiency: Outlook, Word, Excel, PowerPoint, Salesforce CRM.
- Valid driver’s license; meet healthcare industry representative credentialing.
Education and Experience:
- Bachelor’s in healthcare/life sciences/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, payer ecosystems.
- Knowledge of Medicare, Medicaid, and commercial insurance.
Pay Range:
- $136,000 - $204,000
Benefits (explicitly stated):
- Annual bonus and annual equity awards.
- Medical, dental, vision benefits; paid time off (incl. week-long company shutdown in summer and winter); educational assistance/student loan repayment; commuting subsidy; matching charitable donations; 401(k).
Application Instructions:
- Contact recruiter or hiring manager for accommodation requests; for application assistance email ApplicationAssistance@vrtx.com.
- Field-based Field Reimbursement Manager for Vertex Kidney Patient Support Program (KPSP), serving as local subject matter expert to nephrology practices. Provide non-promotional access and reimbursement education and support timely patient access to prescribed Vertex kidney therapies.
Key Duties and Responsibilities:
- Build compliant connections with nephrology office care and administrative staff involved in prior authorizations and patient access.
- Partner with case management to address escalated access issues; coordinate handoffs using CRM triggers and 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 understanding of commercial and government prescription insurance coverage requirements, access needs, and payer trends.
- Conduct compliant on-site/virtual in-services and training on payer policies, formulary updates, coverage nuances; PA/medical exceptions; coding/billing (ICD-10, CPT) and documentation; distribution pathways/hub services/enrollment/reimbursement workflows.
- Independently manage a multi-state region; adapt engagement to office workflows; develop territory engagement plans.
- Adhere to strict non-promotional guidelines; maintain confidentiality of patient health information and comply with laws/regulations/company policies; apply program business rules.
Knowledge and Skills:
- Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCP/office staff.
- Payer portal/CRM/tool navigation; strong communication/training/relationship skills.
- Analytical/data skills for caseload management and prioritization.
- Strategic business/account planning; sound judgment; travel 50–70%.
- Proficiency: Outlook, Word, Excel, PowerPoint, Salesforce CRM.
- Valid driver’s license; meet healthcare industry representative credentialing.
Education and Experience:
- Bachelor’s in healthcare/life sciences/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, payer ecosystems.
- Knowledge of Medicare, Medicaid, and commercial insurance.
Pay Range:
- $136,000 - $204,000
Benefits (explicitly stated):
- Annual bonus and annual equity awards.
- Medical, dental, vision benefits; paid time off (incl. week-long company shutdown in summer and winter); educational assistance/student loan repayment; commuting subsidy; matching charitable donations; 401(k).
Application Instructions:
- Contact recruiter or hiring manager for accommodation requests; for application assistance email ApplicationAssistance@vrtx.com.