Field Reimbursement Manager - Kidney (Pacific Northwest - WA, OR, ID, WY, MT, AK)
Vertex Pharmaceuticals
3 months ago
On-site
Washington, United States
Market Access
General Summary:
Field-based Field Reimbursement Manager for Vertex Kidney Patient Support Program (KPSP). Serve as local subject matter expert to nephrology practices providing non-promotional access and reimbursement education; troubleshoot to support timely patient access to prescribed Vertex kidney therapies.
Key Duties And Responsibilities:
- Build compliant connections with nephrology care teams and administrative staff for prior authorizations and patient access.
- Partner with case management to resolve escalated access issues; use CRM triggers/workflows for coordinated handoffs.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways; provide documentation requirements and timely case follow-up.
- Maintain knowledge of commercial/government coverage requirements and payer trends.
- Conduct compliant on-site/virtual in-services and training on payer policies, formulary/coverage, PA/medical exception criteria, ICD-10/CPT and documentation, and distribution/hub/reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts by patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans; adhere to non-promotional guidelines; maintain patient PHI confidentiality and comply with laws/regulations and company policies.
Knowledge And Skills:
- Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCP/office staff.
- Proficiency with payer portals, CRM and field access tools; strong communication/training/relationship skills.
- Analytical/data skills; ability to travel 50–70%.
- Microsoft Outlook/Word/Excel/PowerPoint; Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education And Experience:
- Bachelor’s in health care, life sciences, or business (advanced degree preferred).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep understanding of benefits investigations, PA, appeals, coverage policies; knowledge of Medicare/Medicaid/commercial.
Pay/Benefits:
- Pay range: $136,000–$204,000. Eligible for annual bonus and annual equity awards; overtime eligibility may apply.
- Total Rewards include medical/dental/vision, paid time off (incl. summer/winter shutdown), educational assistance (incl. student loan repayment), commuting subsidy, matching charitable donations, and 401(k).
Field-based Field Reimbursement Manager for Vertex Kidney Patient Support Program (KPSP). Serve as local subject matter expert to nephrology practices providing non-promotional access and reimbursement education; troubleshoot to support timely patient access to prescribed Vertex kidney therapies.
Key Duties And Responsibilities:
- Build compliant connections with nephrology care teams and administrative staff for prior authorizations and patient access.
- Partner with case management to resolve escalated access issues; use CRM triggers/workflows for coordinated handoffs.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways; provide documentation requirements and timely case follow-up.
- Maintain knowledge of commercial/government coverage requirements and payer trends.
- Conduct compliant on-site/virtual in-services and training on payer policies, formulary/coverage, PA/medical exception criteria, ICD-10/CPT and documentation, and distribution/hub/reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts by patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans; adhere to non-promotional guidelines; maintain patient PHI confidentiality and comply with laws/regulations and company policies.
Knowledge And Skills:
- Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCP/office staff.
- Proficiency with payer portals, CRM and field access tools; strong communication/training/relationship skills.
- Analytical/data skills; ability to travel 50–70%.
- Microsoft Outlook/Word/Excel/PowerPoint; Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education And Experience:
- Bachelor’s in health care, life sciences, or business (advanced degree preferred).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep understanding of benefits investigations, PA, appeals, coverage policies; knowledge of Medicare/Medicaid/commercial.
Pay/Benefits:
- Pay range: $136,000–$204,000. Eligible for annual bonus and annual equity awards; overtime eligibility may apply.
- Total Rewards include medical/dental/vision, paid time off (incl. summer/winter shutdown), educational assistance (incl. student loan repayment), commuting subsidy, matching charitable donations, and 401(k).