Field Reimbursement Manager - Kidney (OH-PA)
Vertex Pharmaceuticals
3 days ago
On-site
Pennsylvania, 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; support timely patient access through troubleshooting and payer expertise.
Key Duties And Responsibilities:
- Establish connections with nephrology office care team and administrative staff (prior authorizations/patient access) to support access to prescribed medications.
- Partner with case management to address escalated access issues; use CRM triggers/workflows for coordinated handoffs.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways.
- Provide timely follow-up on case status and ensure understanding of insurance documentation requirements.
- Maintain understanding of commercial and government prescription insurance coverage requirements, access/payer trends.
- Conduct on-site/virtual in-services and training (compliant education) covering:
- Regional payer policies, formulary updates, coverage nuances.
- PA/medical exception criteria, ICD-10/CPT coding, documentation.
- Distribution pathways, hub services, enrollment, reimbursement workflows.
- Manage a multistate territory independently; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize patient access barriers; align with office workflows.
- Follow strict non-promotional guidelines and legal/compliance/privacy requirements.
- Maintain patient health information confidentiality; apply program business rules for consistent compliant experience.
Knowledge And Skills:
- Specialty biologics/rare disease therapies/complex pharmacy benefit experience.
- Account management with HCP/office staff; navigate payer portals/CRM/field tools.
- Communication/training/relationship-building; analytical and data/reporting skills for caseload prioritization.
- Strategic business/account planning; judgment/problem-solving.
- Travel 50–70%; proficiency with Microsoft Office and Salesforce CRM; valid driver’s license and ability to meet credentialing.
Education And Experience:
- Bachelor’s degree in healthcare/life sciences/business (advanced degree preferred).
- Minimum 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, payer ecosystems.
- Knowledge of Medicare, Medicaid, and commercial plans.
Benefits:
- Eligible for annual bonus and annual equity awards; annual base pay range: $136,000–$204,000.
Application Instructions:
- Submit application through the hiring process (for application assistance: 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; support timely patient access through troubleshooting and payer expertise.
Key Duties And Responsibilities:
- Establish connections with nephrology office care team and administrative staff (prior authorizations/patient access) to support access to prescribed medications.
- Partner with case management to address escalated access issues; use CRM triggers/workflows for coordinated handoffs.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways.
- Provide timely follow-up on case status and ensure understanding of insurance documentation requirements.
- Maintain understanding of commercial and government prescription insurance coverage requirements, access/payer trends.
- Conduct on-site/virtual in-services and training (compliant education) covering:
- Regional payer policies, formulary updates, coverage nuances.
- PA/medical exception criteria, ICD-10/CPT coding, documentation.
- Distribution pathways, hub services, enrollment, reimbursement workflows.
- Manage a multistate territory independently; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize patient access barriers; align with office workflows.
- Follow strict non-promotional guidelines and legal/compliance/privacy requirements.
- Maintain patient health information confidentiality; apply program business rules for consistent compliant experience.
Knowledge And Skills:
- Specialty biologics/rare disease therapies/complex pharmacy benefit experience.
- Account management with HCP/office staff; navigate payer portals/CRM/field tools.
- Communication/training/relationship-building; analytical and data/reporting skills for caseload prioritization.
- Strategic business/account planning; judgment/problem-solving.
- Travel 50–70%; proficiency with Microsoft Office and Salesforce CRM; valid driver’s license and ability to meet credentialing.
Education And Experience:
- Bachelor’s degree in healthcare/life sciences/business (advanced degree preferred).
- Minimum 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, payer ecosystems.
- Knowledge of Medicare, Medicaid, and commercial plans.
Benefits:
- Eligible for annual bonus and annual equity awards; annual base pay range: $136,000–$204,000.
Application Instructions:
- Submit application through the hiring process (for application assistance: ApplicationAssistance@vrtx.com).