Field Reimbursement Manager - Kidney (Pacific Northwest - WA, OR, ID, WY, MT, AK)
Vertex Pharmaceuticals
4 days ago
On-site
Montana, 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 and troubleshoot to support timely patient access to prescribed Vertex kidney therapies.
Key Duties And Responsibilities:
- Build compliant relationships with nephrology care and authorization/access staff.
- Partner with case management for escalated access issues; coordinate handoffs via CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways.
- Follow up on case status; ensure understanding of insurance documentation requirements.
- Maintain knowledge of commercial and government coverage requirements and payer trends.
- Deliver compliant on-site/virtual in-services and training on payer policies, formulary updates, PA/medical exceptions, ICD-10/CPT, documentation, distribution/hub/enrollment, and reimbursement workflows.
- Manage a multistate territory independently; prioritize accounts based on need, payer dynamics, and KPSP demand.
- Develop territory engagement plans; minimize access barriers.
- Follow non-promotional and compliance/privacy guardrails; maintain patient confidentiality and legal/regulatory compliance.
Knowledge And Skills (Qualifications/Requirements):
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCP offices; ability to navigate payer portals/CRM/tools.
- Strong training, relationship-building, analytical, and data/reporting skills.
- Develop/execute strategic business/account plans; sound judgment.
- Travel 50–70%.
- Proficiency: Outlook, Word, Excel, PowerPoint, Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing.
Education And Experience:
- Bachelor’s degree in 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, and payer ecosystems.
- Payer knowledge of Medicare, Medicaid, and commercial plans.
Pay Range:
$136,000–$204,000; eligible for annual bonus and annual equity awards.
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 and troubleshoot to support timely patient access to prescribed Vertex kidney therapies.
Key Duties And Responsibilities:
- Build compliant relationships with nephrology care and authorization/access staff.
- Partner with case management for escalated access issues; coordinate handoffs via CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways.
- Follow up on case status; ensure understanding of insurance documentation requirements.
- Maintain knowledge of commercial and government coverage requirements and payer trends.
- Deliver compliant on-site/virtual in-services and training on payer policies, formulary updates, PA/medical exceptions, ICD-10/CPT, documentation, distribution/hub/enrollment, and reimbursement workflows.
- Manage a multistate territory independently; prioritize accounts based on need, payer dynamics, and KPSP demand.
- Develop territory engagement plans; minimize access barriers.
- Follow non-promotional and compliance/privacy guardrails; maintain patient confidentiality and legal/regulatory compliance.
Knowledge And Skills (Qualifications/Requirements):
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCP offices; ability to navigate payer portals/CRM/tools.
- Strong training, relationship-building, analytical, and data/reporting skills.
- Develop/execute strategic business/account plans; sound judgment.
- Travel 50–70%.
- Proficiency: Outlook, Word, Excel, PowerPoint, Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing.
Education And Experience:
- Bachelor’s degree in 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, and payer ecosystems.
- Payer knowledge of Medicare, Medicaid, and commercial plans.
Pay Range:
$136,000–$204,000; eligible for annual bonus and annual equity awards.