Field Reimbursement Manager - Kidney (Pacific Northwest - WA, OR, ID, WY, MT, AK)
Vertex Pharmaceuticals
3 days ago
On-site
Oregon, United States
Market Access
General Summary:
Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP). Serve as local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education. Support timely patient access through troubleshooting and territory-level payer expertise.
Key Duties and Responsibilities:
- Build compliant relationships with nephrology office staff involved in prior authorizations and patient access.
- Partner with case management to resolve escalated access issues; manage coordinated handoffs using CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways.
- Follow up on case status and ensure offices understand required insurance documentation.
- Maintain knowledge of commercial and government prescription coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, formulary updates, coverage nuances, PA/medical exception criteria, ICD-10/CPT coding, documentation, and reimbursement workflows.
- Manage a multistate territory independently; prioritize accounts by patient need and payer dynamics.
- Develop territory engagement plans to minimize patient-specific access barriers.
- Adhere to non-promotional compliance guidelines; protect confidential patient health information.
Knowledge, Skills, and Qualifications:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCPs/office staff for specialty access.
- Navigate payer portals and CRM; strong training/relationship-building and analytical skills.
- Ability to leverage data/reporting tools; strategic business/account planning experience.
- Travel 50–70%; Microsoft Outlook/Word/Excel/PowerPoint/Salesforce CRM.
- Valid driver’s license and ability to meet credentialing requirements.
Education/Experience:
- Bachelor’s degree in healthcare/life sciences/business (advanced degree a plus).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep understanding of benefits investigations, PA/appeals, and coverage policies; payer knowledge of Medicare/Medicaid/commercial.
Pay Range:
$136,000 - $204,000
Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP). Serve as local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education. Support timely patient access through troubleshooting and territory-level payer expertise.
Key Duties and Responsibilities:
- Build compliant relationships with nephrology office staff involved in prior authorizations and patient access.
- Partner with case management to resolve escalated access issues; manage coordinated handoffs using CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways.
- Follow up on case status and ensure offices understand required insurance documentation.
- Maintain knowledge of commercial and government prescription coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, formulary updates, coverage nuances, PA/medical exception criteria, ICD-10/CPT coding, documentation, and reimbursement workflows.
- Manage a multistate territory independently; prioritize accounts by patient need and payer dynamics.
- Develop territory engagement plans to minimize patient-specific access barriers.
- Adhere to non-promotional compliance guidelines; protect confidential patient health information.
Knowledge, Skills, and Qualifications:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCPs/office staff for specialty access.
- Navigate payer portals and CRM; strong training/relationship-building and analytical skills.
- Ability to leverage data/reporting tools; strategic business/account planning experience.
- Travel 50–70%; Microsoft Outlook/Word/Excel/PowerPoint/Salesforce CRM.
- Valid driver’s license and ability to meet credentialing requirements.
Education/Experience:
- Bachelor’s degree in healthcare/life sciences/business (advanced degree a plus).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep understanding of benefits investigations, PA/appeals, and coverage policies; payer knowledge of Medicare/Medicaid/commercial.
Pay Range:
$136,000 - $204,000