Field Reimbursement Manager - Kidney (NYC Metro)
Vertex Pharmaceuticals
3 days ago
On-site
United States
Market Access
General Summary:
Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP), serving as a local subject matter expert to nephrology practices. Provide non-promotional access and reimbursement education and troubleshoot to support timely patient access.
Key Duties And Responsibilities:
- Establish compliant connections with nephrology office personnel involved in prior authorizations and patient access.
- Partner with case management to resolve escalated access issues; coordinate handoffs via 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 knowledge of commercial and government prescription coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, PA/medical exception criteria, ICD-10/CPT coding, documentation, distribution pathways, hub services, enrollment processes, and reimbursement workflows.
- Manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize access barriers.
- Follow strict non-promotional guidelines and comply with legal/compliance/privacy guardrails; maintain patient confidentiality.
Knowledge And Skills:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCP offices; navigate payer portals/CRM/tools.
- Strong communication, training, analytics, and data/reporting skills.
- Ability to 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 (health care/life sciences/business); advanced degree preferred.
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles.
- Deep understanding of benefits investigations, PA, appeals, coverage policies; knowledge of Medicare/Medicaid/commercial.
Pay Range: $136,000 - $204,000
Benefits (as stated): Eligible for annual bonus and annual equity awards; may be eligible for overtime; Total Rewards include medical/dental/vision, paid time off, educational assistance (including student loan repayment), commuting subsidy, charitable matching, and 401(k).
Application: Apply via standard recruiting process; for application assistance contact ApplicationAssistance@vrtx.com.
Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP), serving as a local subject matter expert to nephrology practices. Provide non-promotional access and reimbursement education and troubleshoot to support timely patient access.
Key Duties And Responsibilities:
- Establish compliant connections with nephrology office personnel involved in prior authorizations and patient access.
- Partner with case management to resolve escalated access issues; coordinate handoffs via 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 knowledge of commercial and government prescription coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, PA/medical exception criteria, ICD-10/CPT coding, documentation, distribution pathways, hub services, enrollment processes, and reimbursement workflows.
- Manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize access barriers.
- Follow strict non-promotional guidelines and comply with legal/compliance/privacy guardrails; maintain patient confidentiality.
Knowledge And Skills:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCP offices; navigate payer portals/CRM/tools.
- Strong communication, training, analytics, and data/reporting skills.
- Ability to 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 (health care/life sciences/business); advanced degree preferred.
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles.
- Deep understanding of benefits investigations, PA, appeals, coverage policies; knowledge of Medicare/Medicaid/commercial.
Pay Range: $136,000 - $204,000
Benefits (as stated): Eligible for annual bonus and annual equity awards; may be eligible for overtime; Total Rewards include medical/dental/vision, paid time off, educational assistance (including student loan repayment), commuting subsidy, charitable matching, and 401(k).
Application: Apply via standard recruiting process; for application assistance contact ApplicationAssistance@vrtx.com.