Field Reimbursement Manager - Kidney (South Central - AR, MS, LA, TN)
Vertex Pharmaceuticals
3 days ago
On-site
Arkansas, United States
Market Access
Field Reimbursement Manager (Kidney Patient Support Program – KPSP)
General Summary:
Field-based role serving as local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education; supports timely patient access through troubleshooting and territory payer expertise.
Key Duties And Responsibilities:
- Establish compliant connections with nephrology office care/admin staff to support prior authorizations and patient access to specialty medications.
- Partner with case management to resolve escalated access issues; ensure coordinated handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways; provide follow-up on case status and insurance documentation requirements.
- Maintain knowledge of commercial and government prescription insurance coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on regional payer policies, formulary updates, PA/medical exception criteria, ICD-10/CPT coding & documentation, distribution pathways/hub services, enrollment processes, and reimbursement workflows.
- Independently manage a multistate territory; develop territory engagement plans to minimize access barriers.
- Follow non-promotional and all compliance/privacy and confidentiality requirements; apply program business rules for consistent patient/customer experience.
Knowledge And Skills:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCP offices; ability to navigate payer portals, CRM systems, and field access tools.
- Strong training/relationship-building, analytical, and data/reporting skills; strategic account planning.
- Travel 50–70% within territory; proficiency in MS Outlook/Word/Excel/PowerPoint/Salesforce CRM; valid driver’s license and ability to meet credentialing requirements.
Education And Experience:
- Bachelor’s degree (health care, life sciences, or business); advanced degree preferred.
- 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/commercial plans.
Pay Range:
$136,000–$204,000 (eligible for annual bonus and annual equity awards).
General Summary:
Field-based role serving as local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education; supports timely patient access through troubleshooting and territory payer expertise.
Key Duties And Responsibilities:
- Establish compliant connections with nephrology office care/admin staff to support prior authorizations and patient access to specialty medications.
- Partner with case management to resolve escalated access issues; ensure coordinated handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways; provide follow-up on case status and insurance documentation requirements.
- Maintain knowledge of commercial and government prescription insurance coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on regional payer policies, formulary updates, PA/medical exception criteria, ICD-10/CPT coding & documentation, distribution pathways/hub services, enrollment processes, and reimbursement workflows.
- Independently manage a multistate territory; develop territory engagement plans to minimize access barriers.
- Follow non-promotional and all compliance/privacy and confidentiality requirements; apply program business rules for consistent patient/customer experience.
Knowledge And Skills:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCP offices; ability to navigate payer portals, CRM systems, and field access tools.
- Strong training/relationship-building, analytical, and data/reporting skills; strategic account planning.
- Travel 50–70% within territory; proficiency in MS Outlook/Word/Excel/PowerPoint/Salesforce CRM; valid driver’s license and ability to meet credentialing requirements.
Education And Experience:
- Bachelor’s degree (health care, life sciences, or business); advanced degree preferred.
- 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/commercial plans.
Pay Range:
$136,000–$204,000 (eligible for annual bonus and annual equity awards).