Field Reimbursement Manager - Kidney (NJ-MD-DE)
Vertex Pharmaceuticals
4 days ago
On-site
Pennsylvania, United States
Market Access
General Summary (role purpose): 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 troubleshoot to support timely patient access to prescribed Vertex kidney therapies.
Key Duties and Responsibilities:
- Build compliant relationships with nephrology office personnel (care team and prior authorization/access staff).
- Coordinate escalated access issues with case management; ensure handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways; provide timely follow-up and documentation guidance.
- Maintain understanding of commercial and government prescription coverage, payer trends, and PA/exception requirements.
- Conduct compliant on-site and virtual in-services/trainings covering payer policies, formulary updates, PA/exception criteria, ICD-10/CPT, documentation, distribution/hub services, enrollment, and reimbursement workflows.
- Manage a multistate territory independently; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Follow strict non-promotional guidelines; maintain patient confidentiality and compliance with laws/policies.
Knowledge/Skills:
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCP offices.
- Navigate payer portals and CRM/tools; strong training/communication, analytical and data/reporting skills.
- Travel 50–70%; proficiency in Microsoft Office and Salesforce CRM; valid driver’s license; ability to meet healthcare representative credentialing.
Education/Experience:
- Bachelor’s in health care/life sciences/business (advanced degree a plus); 5+ years in sales/reimbursement/market access/specialty pharmacy/patient services/field access.
- Deep benefits investigation/PA/appeals/coverage policy knowledge; strong Medicare/Medicaid/commercial payer knowledge.
Pay Range: $136,000–$204,000. Eligible for annual bonus and annual equity; may be eligible for overtime (per law).
Application: For accommodation requests related to hiring/process, contact ApplicationAssistance@vrtx.com.
Key Duties and Responsibilities:
- Build compliant relationships with nephrology office personnel (care team and prior authorization/access staff).
- Coordinate escalated access issues with case management; ensure handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways; provide timely follow-up and documentation guidance.
- Maintain understanding of commercial and government prescription coverage, payer trends, and PA/exception requirements.
- Conduct compliant on-site and virtual in-services/trainings covering payer policies, formulary updates, PA/exception criteria, ICD-10/CPT, documentation, distribution/hub services, enrollment, and reimbursement workflows.
- Manage a multistate territory independently; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Follow strict non-promotional guidelines; maintain patient confidentiality and compliance with laws/policies.
Knowledge/Skills:
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCP offices.
- Navigate payer portals and CRM/tools; strong training/communication, analytical and data/reporting skills.
- Travel 50–70%; proficiency in Microsoft Office and Salesforce CRM; valid driver’s license; ability to meet healthcare representative credentialing.
Education/Experience:
- Bachelor’s in health care/life sciences/business (advanced degree a plus); 5+ years in sales/reimbursement/market access/specialty pharmacy/patient services/field access.
- Deep benefits investigation/PA/appeals/coverage policy knowledge; strong Medicare/Medicaid/commercial payer knowledge.
Pay Range: $136,000–$204,000. Eligible for annual bonus and annual equity; may be eligible for overtime (per law).
Application: For accommodation requests related to hiring/process, contact ApplicationAssistance@vrtx.com.