Field Reimbursement Manager - Kidney (Pacific Northwest - WA, OR, ID, WY, MT, AK)
Vertex Pharmaceuticals
3 months ago
On-site
Idaho, United States
Market Access
General Summary:
Field-based Field Reimbursement Manager for Kidney Patient Support Program (KPSP), serving as non-promotional access and reimbursement education subject matter expert to nephrology practices and supporting timely patient access to prescribed therapies through troubleshooting and payer expertise.
Key Duties and Responsibilities:
- Establish compliant relationships with nephrology care team and administrative staff (prior authorizations/patient access).
- Partner with case management to address escalated access issues; coordinate handoffs via CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways.
- Follow up on case status and ensure offices understand insurance documentation requirements.
- Maintain understanding of commercial and government prescription insurance coverage requirements and payer trends.
- Conduct compliant on-site/virtual in-services and training on payer policies/formulary/coverage nuances; PA/medical exception criteria; ICD-10/CPT and documentation; distribution pathways, hub services, enrollment, and reimbursement workflows.
- Manage a multistate region independently; develop territory engagement plans to minimize access barriers.
- Adhere to non-promotional guidelines, comply with legal/compliance/privacy guardrails, and maintain patient confidentiality.
Knowledge & Skills:
- Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCPs.
- Navigate payer portals/CRM and field tools; strong training/relationship-building; analytical and data/reporting skills.
- Strategic account planning, judgment/problem-solving; travel 50–70%.
- MS Outlook/Word/Excel/PowerPoint; Salesforce CRM.
- Valid driver’s license; meet healthcare credentialing requirements.
Education & Experience:
- Bachelor’s in healthcare/life sciences/business (advanced degree a plus); 5+ years in reimbursement/market access/specialty pharmacy/patient services/field access.
- Deep PA/appeals/coverage-policy understanding; Medicare/Medicaid/commercial payer knowledge.
Pay Range:
- $136,000–$204,000 (eligible for annual bonus and annual equity awards).
Field-based Field Reimbursement Manager for Kidney Patient Support Program (KPSP), serving as non-promotional access and reimbursement education subject matter expert to nephrology practices and supporting timely patient access to prescribed therapies through troubleshooting and payer expertise.
Key Duties and Responsibilities:
- Establish compliant relationships with nephrology care team and administrative staff (prior authorizations/patient access).
- Partner with case management to address escalated access issues; coordinate handoffs via CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways.
- Follow up on case status and ensure offices understand insurance documentation requirements.
- Maintain understanding of commercial and government prescription insurance coverage requirements and payer trends.
- Conduct compliant on-site/virtual in-services and training on payer policies/formulary/coverage nuances; PA/medical exception criteria; ICD-10/CPT and documentation; distribution pathways, hub services, enrollment, and reimbursement workflows.
- Manage a multistate region independently; develop territory engagement plans to minimize access barriers.
- Adhere to non-promotional guidelines, comply with legal/compliance/privacy guardrails, and maintain patient confidentiality.
Knowledge & Skills:
- Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCPs.
- Navigate payer portals/CRM and field tools; strong training/relationship-building; analytical and data/reporting skills.
- Strategic account planning, judgment/problem-solving; travel 50–70%.
- MS Outlook/Word/Excel/PowerPoint; Salesforce CRM.
- Valid driver’s license; meet healthcare credentialing requirements.
Education & Experience:
- Bachelor’s in healthcare/life sciences/business (advanced degree a plus); 5+ years in reimbursement/market access/specialty pharmacy/patient services/field access.
- Deep PA/appeals/coverage-policy understanding; Medicare/Medicaid/commercial payer knowledge.
Pay Range:
- $136,000–$204,000 (eligible for annual bonus and annual equity awards).