Field Reimbursement Manager - Kidney (Northern California - San Francisco, San Jose, Sacramento)
Vertex Pharmaceuticals
3 days ago
On-site
Nevada, United States
Market Access
General Summary:
- Field-based Field Reimbursement Manager for Vertex’s 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 administrative staff) to support patient access and prior authorizations.
- Partner with case management to address escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways; provide timely follow-up on case status and documentation requirements.
- Maintain understanding of commercial and government prescription insurance coverage and payer trends.
- Conduct on-site/virtual in-services and training on regional payer policies, formulary updates, coverage nuances, PA/medical exception criteria, ICD-10/CPT coding/documentation requirements, and distribution/hub/reimbursement workflows.
- Independently manage a multistate region; prioritize accounts based on patient need, payer dynamics, and KPSP demand; adapt engagement to office workflows.
- Develop territory engagement plans; adhere to strict non-promotional guidelines and confidentiality.
Knowledge/Skills:
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCP/office staff.
- Payer portal/CRM tool navigation; strong communication, training, analytics, and data/reporting use.
- Strategic account plan experience; sound judgment; travel 50–70%; MS Outlook/Word/Excel/PowerPoint/Salesforce.
- Valid driver’s license and ability to meet credentialing requirements.
Education/Experience:
- Bachelor’s in healthcare/life sciences/business (advanced degree preferred).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles.
- Deep benefits investigation/PA/appeals/coverage policy knowledge; payer knowledge of Medicare/Medicaid/commercial plans.
Compensation/Benefits (if eligible):
- Annual bonus and annual equity awards; overtime may apply where required.
- Medical/dental/vision, paid time off (incl. summer/winter shutdown), educational assistance (incl. student loan repayment), commuting subsidy, 401(k), and other benefits.
Application Instructions:
- Contact recruiter/hiring manager for accommodation requests; Talent Acquisition: ApplicationAssistance@vrtx.com.
- Field-based Field Reimbursement Manager for Vertex’s 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 administrative staff) to support patient access and prior authorizations.
- Partner with case management to address escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways; provide timely follow-up on case status and documentation requirements.
- Maintain understanding of commercial and government prescription insurance coverage and payer trends.
- Conduct on-site/virtual in-services and training on regional payer policies, formulary updates, coverage nuances, PA/medical exception criteria, ICD-10/CPT coding/documentation requirements, and distribution/hub/reimbursement workflows.
- Independently manage a multistate region; prioritize accounts based on patient need, payer dynamics, and KPSP demand; adapt engagement to office workflows.
- Develop territory engagement plans; adhere to strict non-promotional guidelines and confidentiality.
Knowledge/Skills:
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCP/office staff.
- Payer portal/CRM tool navigation; strong communication, training, analytics, and data/reporting use.
- Strategic account plan experience; sound judgment; travel 50–70%; MS Outlook/Word/Excel/PowerPoint/Salesforce.
- Valid driver’s license and ability to meet credentialing requirements.
Education/Experience:
- Bachelor’s in healthcare/life sciences/business (advanced degree preferred).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles.
- Deep benefits investigation/PA/appeals/coverage policy knowledge; payer knowledge of Medicare/Medicaid/commercial plans.
Compensation/Benefits (if eligible):
- Annual bonus and annual equity awards; overtime may apply where required.
- Medical/dental/vision, paid time off (incl. summer/winter shutdown), educational assistance (incl. student loan repayment), commuting subsidy, 401(k), and other benefits.
Application Instructions:
- Contact recruiter/hiring manager for accommodation requests; Talent Acquisition: ApplicationAssistance@vrtx.com.