Field Reimbursement Manager - Kidney (North Central - IA, MO, IL)
Vertex Pharmaceuticals
4 days ago
On-site
Illinois, United States
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/reimbursement education and supporting timely patient access through troubleshooting and territory payer expertise.
Key Duties And Responsibilities:
- Build compliant relationships with nephrology office personnel involved in prior authorizations and patient access.
- Partner with case management to address escalated access issues; coordinate handoffs via CRM triggers/workflows.
- Educate offices on copay/PAP/Bridge programs and other affordability pathways to support timely access.
- Provide timely case follow-up and ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial/government coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, formulary/coverage nuances, PA/medical exceptions, ICD-10/CPT, documentation, distribution/hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts by patient need, payer dynamics, and KPSP demand.
- Ensure strict non-promotional, compliant engagements; maintain patient confidentiality; apply program business rules.
Knowledge And Skills (Qualifications):
- Specialty biologics/rare disease/complex pharmacy benefit experience.
- Account management with HCPs/office staff; ability to navigate payer portals/CRM/tools.
- Strong communication/training/relationship-building; analytical and data-driven caseload prioritization.
- Strategic business/account plan experience; sound judgment.
- Travel 50–70%.
- MS Outlook/Word/Excel/PowerPoint; Salesforce CRM.
- Valid driver’s license and ability to meet credentialing requirements.
Education And Experience:
- Bachelor’s degree in healthcare/life sciences/business (advanced degree preferred).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field access roles.
- Deep understanding of benefits investigations, PA processes/appeals, coverage policies, and payer ecosystems (Medicare/Medicaid/commercial).
Pay Range:
$136,000–$204,000; eligible for annual bonus and annual equity awards.
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/reimbursement education and supporting timely patient access through troubleshooting and territory payer expertise.
Key Duties And Responsibilities:
- Build compliant relationships with nephrology office personnel involved in prior authorizations and patient access.
- Partner with case management to address escalated access issues; coordinate handoffs via CRM triggers/workflows.
- Educate offices on copay/PAP/Bridge programs and other affordability pathways to support timely access.
- Provide timely case follow-up and ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial/government coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, formulary/coverage nuances, PA/medical exceptions, ICD-10/CPT, documentation, distribution/hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts by patient need, payer dynamics, and KPSP demand.
- Ensure strict non-promotional, compliant engagements; maintain patient confidentiality; apply program business rules.
Knowledge And Skills (Qualifications):
- Specialty biologics/rare disease/complex pharmacy benefit experience.
- Account management with HCPs/office staff; ability to navigate payer portals/CRM/tools.
- Strong communication/training/relationship-building; analytical and data-driven caseload prioritization.
- Strategic business/account plan experience; sound judgment.
- Travel 50–70%.
- MS Outlook/Word/Excel/PowerPoint; Salesforce CRM.
- Valid driver’s license and ability to meet credentialing requirements.
Education And Experience:
- Bachelor’s degree in healthcare/life sciences/business (advanced degree preferred).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field access roles.
- Deep understanding of benefits investigations, PA processes/appeals, coverage policies, and payer ecosystems (Medicare/Medicaid/commercial).
Pay Range:
$136,000–$204,000; eligible for annual bonus and annual equity awards.