Field Reimbursement Manager - Kidney (NJ-MD-DE)
Vertex Pharmaceuticals
4 days ago
On-site
Indian Field, DE
Market Access
General Summary:
Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP). Serve as a 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:
- Build compliant relationships with nephrology office staff to support prior authorization and patient access.
- Partner with case management to resolve escalated access issues; coordinate handoffs using CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways; follow up on case status and insurance documentation requirements.
- Maintain knowledge of commercial and government coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, PA/medical exception criteria, ICD-10/CPT coding, documentation, distribution/hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; develop engagement plans based on local payer landscapes.
- Adhere to strict non-promotional and compliance/privacy guidelines; maintain patient confidentiality.
Knowledge and Skills:
- Specialty biologics/rare disease and complex pharmacy benefit experience; account management with HCPs.
- Ability to navigate payer portals and CRM tools; strong training/relationship skills.
- Analytical skills; data/reporting to manage caseload and prioritize.
- Travel 50–70%; proficiency with Microsoft Office and Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education and Experience:
- Bachelor’s degree (health care/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/appeals, and Medicare/Medicaid/commercial payers.
Compensation/Benefits:
- Pay range: $136,000–$204,000; eligible for annual bonus and annual equity awards. Additional benefits include medical/dental/vision, paid time off, education assistance (e.g., student loan repayment), commuting subsidy, charitable donations, and 401(k).
Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP). Serve as a 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:
- Build compliant relationships with nephrology office staff to support prior authorization and patient access.
- Partner with case management to resolve escalated access issues; coordinate handoffs using CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways; follow up on case status and insurance documentation requirements.
- Maintain knowledge of commercial and government coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, PA/medical exception criteria, ICD-10/CPT coding, documentation, distribution/hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; develop engagement plans based on local payer landscapes.
- Adhere to strict non-promotional and compliance/privacy guidelines; maintain patient confidentiality.
Knowledge and Skills:
- Specialty biologics/rare disease and complex pharmacy benefit experience; account management with HCPs.
- Ability to navigate payer portals and CRM tools; strong training/relationship skills.
- Analytical skills; data/reporting to manage caseload and prioritize.
- Travel 50–70%; proficiency with Microsoft Office and Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education and Experience:
- Bachelor’s degree (health care/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/appeals, and Medicare/Medicaid/commercial payers.
Compensation/Benefits:
- Pay range: $136,000–$204,000; eligible for annual bonus and annual equity awards. Additional benefits include medical/dental/vision, paid time off, education assistance (e.g., student loan repayment), commuting subsidy, charitable donations, and 401(k).