Field Reimbursement Manager - Kidney (North Carolina-Virginia)
Vertex Pharmaceuticals
3 days ago
On-site
Virginia, United States
Market Access
General Summary:
Field-based role as Field Reimbursement Manager for Vertex Kidney Patient Support Program (KPSP), serving as local subject matter expert to nephrology practices and providing non-promotional access and reimbursement education. Support timely patient access through troubleshooting and territory-level payer expertise.
Key Duties And Responsibilities:
- Compliantly establish connections with nephrology office care team and administrative staff involved in prior authorizations and specialty medication access.
- Partner with case management to address escalated access issues; ensure coordinated handoffs using 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 understanding of commercial and government prescription insurance coverage requirements, access, and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, formulary updates, coverage nuances; PA/medical exception criteria; coding/billing (ICD-10, CPT); documentation requirements; distribution/hub services, enrollment processes, and reimbursement workflows.
- Independently manage a multistate region; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans; adhere to non-promotional, compliant engagement and confidentiality requirements.
- Apply program business rules and work instructions for consistent, compliant experience.
Knowledge And Skills (Required/Preferred):
- Experience with specialty biologics/rare disease or complex pharmacy benefit products.
- Account management with HCP/office staff; payer portal/CRM tool navigation.
- Strong communication, training, relationship-building, analytical, and data/reporting skills.
- Experience developing strategic business/account plans; sound judgment.
- Travel 50–70% in territory; Microsoft Outlook/Word/Excel/PowerPoint/Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education And Experience:
- Bachelor’s degree (health care, life sciences, or business); advanced degree is 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, coverage policies; payer knowledge (Medicare, Medicaid, commercial).
Pay Range:
$136,000 - $204,000
Benefits (as stated):
Eligible for annual bonus and annual equity awards; inclusive total rewards including medical/dental/vision, paid time off (summer/winter shutdown), educational assistance/student loan repayment, commuting subsidy, matching charitable donations, and 401(k).
Application Instructions:
Contact Talent Acquisition at ApplicationAssistance@vrtx.com for accommodation requests related to hiring or performing job functions.
Field-based role as Field Reimbursement Manager for Vertex Kidney Patient Support Program (KPSP), serving as local subject matter expert to nephrology practices and providing non-promotional access and reimbursement education. Support timely patient access through troubleshooting and territory-level payer expertise.
Key Duties And Responsibilities:
- Compliantly establish connections with nephrology office care team and administrative staff involved in prior authorizations and specialty medication access.
- Partner with case management to address escalated access issues; ensure coordinated handoffs using 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 understanding of commercial and government prescription insurance coverage requirements, access, and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, formulary updates, coverage nuances; PA/medical exception criteria; coding/billing (ICD-10, CPT); documentation requirements; distribution/hub services, enrollment processes, and reimbursement workflows.
- Independently manage a multistate region; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans; adhere to non-promotional, compliant engagement and confidentiality requirements.
- Apply program business rules and work instructions for consistent, compliant experience.
Knowledge And Skills (Required/Preferred):
- Experience with specialty biologics/rare disease or complex pharmacy benefit products.
- Account management with HCP/office staff; payer portal/CRM tool navigation.
- Strong communication, training, relationship-building, analytical, and data/reporting skills.
- Experience developing strategic business/account plans; sound judgment.
- Travel 50–70% in territory; Microsoft Outlook/Word/Excel/PowerPoint/Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education And Experience:
- Bachelor’s degree (health care, life sciences, or business); advanced degree is 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, coverage policies; payer knowledge (Medicare, Medicaid, commercial).
Pay Range:
$136,000 - $204,000
Benefits (as stated):
Eligible for annual bonus and annual equity awards; inclusive total rewards including medical/dental/vision, paid time off (summer/winter shutdown), educational assistance/student loan repayment, commuting subsidy, matching charitable donations, and 401(k).
Application Instructions:
Contact Talent Acquisition at ApplicationAssistance@vrtx.com for accommodation requests related to hiring or performing job functions.