Field Reimbursement Manager - Kidney (Northern California - San Francisco, San Jose, Sacramento)
Vertex Pharmaceuticals
3 days ago
On-site
California, United States
Market Access
Field Reimbursement Manager (Kidney Patient Support Program, KPSP)
Key Duties And Responsibilities:
- Compliantly connect with nephrology office personnel (care team and prior authorization/patient access staff) to support access to prescribed medications.
- Partner with case management to address escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways to support timely patient access.
- Provide timely case status follow-up and ensure understanding of insurance documentation requirements.
- Maintain knowledge of commercial and government insurance coverage requirements, access, and payer trends.
- Conduct compliant on-site/virtual in-services and training on payer policies, formulary updates, PA/medical exception criteria, ICD-10/CPT coding, documentation, distribution/hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize patient-specific access barriers.
- Follow strict non-promotional guidelines; maintain patient confidentiality and comply with laws/regulations and company policies.
Knowledge And Skills:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management experience with HCPs/office staff; ability to navigate payer portals, CRM systems, and field access tools.
- Strong communication/training/relationship-building; analytical skills; ability to use data/reporting to manage caseload and prioritize.
- Strategic business/account plan experience; good judgment/problem-solving.
- 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 in health care/life sciences/business (advanced degree 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, and payer ecosystems.
Benefits/Pay/Applications:
- Pay range: $136,000 - $204,000. Eligible for annual bonus and annual equity awards.
- Application: contact Talent Acquisition at ApplicationAssistance@vrtx.com if accommodation is needed.
Key Duties And Responsibilities:
- Compliantly connect with nephrology office personnel (care team and prior authorization/patient access staff) to support access to prescribed medications.
- Partner with case management to address escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways to support timely patient access.
- Provide timely case status follow-up and ensure understanding of insurance documentation requirements.
- Maintain knowledge of commercial and government insurance coverage requirements, access, and payer trends.
- Conduct compliant on-site/virtual in-services and training on payer policies, formulary updates, PA/medical exception criteria, ICD-10/CPT coding, documentation, distribution/hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize patient-specific access barriers.
- Follow strict non-promotional guidelines; maintain patient confidentiality and comply with laws/regulations and company policies.
Knowledge And Skills:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management experience with HCPs/office staff; ability to navigate payer portals, CRM systems, and field access tools.
- Strong communication/training/relationship-building; analytical skills; ability to use data/reporting to manage caseload and prioritize.
- Strategic business/account plan experience; good judgment/problem-solving.
- 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 in health care/life sciences/business (advanced degree 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, and payer ecosystems.
Benefits/Pay/Applications:
- Pay range: $136,000 - $204,000. Eligible for annual bonus and annual equity awards.
- Application: contact Talent Acquisition at ApplicationAssistance@vrtx.com if accommodation is needed.