Field Reimbursement Manager - Kidney (OH-PA)
Vertex Pharmaceuticals
4 days ago
On-site
Ohio, 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 with non-promotional access and reimbursement education; troubleshooting to support timely patient access to prescribed kidney therapies.
Key Duties and Responsibilities:
- Build compliant relationships with nephrology office care and authorization/patient access personnel.
- Partner with case management to resolve 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; ensure offices understand insurance documentation requirements.
- Maintain understanding of commercial/government insurance coverage requirements and payer trends.
- Conduct compliant on-site/virtual in-services and training on payer policies, formulary updates, coverage nuances, PA/medical exceptions, ICD-10/CPT, documentation, and reimbursement workflows/hub services/enrollment.
- Independently manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize access barriers; adhere to non-promotional guidelines, compliance/privacy guardrails, and patient confidentiality.
Knowledge and Skills:
- Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCP offices.
- Payer portal/CRM tool navigation; strong training/relationship-building, analytical/reporting skills.
- Strategic business/account plan experience; sound judgment.
- Travel 50–70%.
- Proficient: Outlook, Word, Excel, PowerPoint, Salesforce CRM.
- Valid driver’s license; meet credentialing requirements.
Education and Experience:
- Bachelor’s degree (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; Medicare/Medicaid/commercial knowledge.
Pay Range:
$136,000–$204,000 (role may be eligible for annual bonus and equity).
Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP), serving as local subject matter expert to nephrology practices with non-promotional access and reimbursement education; troubleshooting to support timely patient access to prescribed kidney therapies.
Key Duties and Responsibilities:
- Build compliant relationships with nephrology office care and authorization/patient access personnel.
- Partner with case management to resolve 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; ensure offices understand insurance documentation requirements.
- Maintain understanding of commercial/government insurance coverage requirements and payer trends.
- Conduct compliant on-site/virtual in-services and training on payer policies, formulary updates, coverage nuances, PA/medical exceptions, ICD-10/CPT, documentation, and reimbursement workflows/hub services/enrollment.
- Independently manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize access barriers; adhere to non-promotional guidelines, compliance/privacy guardrails, and patient confidentiality.
Knowledge and Skills:
- Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCP offices.
- Payer portal/CRM tool navigation; strong training/relationship-building, analytical/reporting skills.
- Strategic business/account plan experience; sound judgment.
- Travel 50–70%.
- Proficient: Outlook, Word, Excel, PowerPoint, Salesforce CRM.
- Valid driver’s license; meet credentialing requirements.
Education and Experience:
- Bachelor’s degree (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; Medicare/Medicaid/commercial knowledge.
Pay Range:
$136,000–$204,000 (role may be eligible for annual bonus and equity).