Field Reimbursement Manager - Kidney (Pacific Northwest - WA, OR, ID, WY, MT, AK)
Vertex Pharmaceuticals
3 months ago
On-site
Wyoming, 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, providing non-promotional access and reimbursement education, and troubleshooting to support timely patient access to prescribed Vertex kidney therapies.
Key Duties and Responsibilities:
- Build compliant relationships with nephrology office care teams and administrative staff for prior authorizations and patient access to specialty medications.
- Partner with case management to address escalated access issues and coordinate handoffs via CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways; provide follow-up on case status and documentation requirements.
- Maintain knowledge of commercial and government prescription insurance coverage 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, distribution pathways, hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts by patient need, payer dynamics, and KPSP demand; develop territory engagement plans to minimize access barriers.
- Follow strict non-promotional, compliant/legal/privacy guidelines; maintain patient confidentiality; apply program business rules.
Knowledge and Skills:
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCP/office staff.
- Proficiency with payer portals, CRM and field access tools; strong communication/training and relationship-building.
- Analytical skills; ability to leverage data/reporting; strategic business/account planning; sound judgment.
- Travel 50–70%; MS Outlook/Word/Excel/PowerPoint/Salesforce CRM; valid driver’s license; ability to meet healthcare rep credentialing.
Education and Experience:
- Bachelor’s degree (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; knowledge of Medicare, Medicaid, and commercial plans.
Benefits/Pay Range:
- Pay range: $136,000–$204,000. Eligible for annual bonus and annual equity awards.
Application Instructions:
- Contact Talent Acquisition at ApplicationAssistance@vrtx.com for accommodation requests related to hiring process or essential functions.
Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP) serving as local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education, and troubleshooting to support timely patient access to prescribed Vertex kidney therapies.
Key Duties and Responsibilities:
- Build compliant relationships with nephrology office care teams and administrative staff for prior authorizations and patient access to specialty medications.
- Partner with case management to address escalated access issues and coordinate handoffs via CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways; provide follow-up on case status and documentation requirements.
- Maintain knowledge of commercial and government prescription insurance coverage 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, distribution pathways, hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts by patient need, payer dynamics, and KPSP demand; develop territory engagement plans to minimize access barriers.
- Follow strict non-promotional, compliant/legal/privacy guidelines; maintain patient confidentiality; apply program business rules.
Knowledge and Skills:
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCP/office staff.
- Proficiency with payer portals, CRM and field access tools; strong communication/training and relationship-building.
- Analytical skills; ability to leverage data/reporting; strategic business/account planning; sound judgment.
- Travel 50–70%; MS Outlook/Word/Excel/PowerPoint/Salesforce CRM; valid driver’s license; ability to meet healthcare rep credentialing.
Education and Experience:
- Bachelor’s degree (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; knowledge of Medicare, Medicaid, and commercial plans.
Benefits/Pay Range:
- Pay range: $136,000–$204,000. Eligible for annual bonus and annual equity awards.
Application Instructions:
- Contact Talent Acquisition at ApplicationAssistance@vrtx.com for accommodation requests related to hiring process or essential functions.