Field Reimbursement Manager - Kidney (South Central - AR, MS, LA, TN)
Vertex Pharmaceuticals
4 days ago
On-site
Tennessee, United States
Market Access
Field Reimbursement Manager (Kidney Patient Support Program - KPSP)
Key Duties and Responsibilities
- Build compliant relationships with nephrology office personnel (care team and prior authorization/access administrators).
- Partner with case management to resolve escalated access issues and ensure coordinated handoffs (CRM triggers/workflows).
- Educate offices on copay, PAP, Bridge programs, and affordability pathways to support timely patient access.
- Follow up on case status and ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government prescription coverage requirements and payer trends.
- Conduct compliant on-site/virtual in-services and training on regional payer policies, formulary updates, PA/medical exception criteria, ICD-10/CPT coding and documentation, and distribution/hub/reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans and minimize patient-specific access barriers.
- Adhere to non-promotional guidelines; protect patient health information and follow all applicable laws/regulations and company policies.
Knowledge and Skills / Qualifications
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCP offices; strong payer investigation and PA/appeals/coverage knowledge.
- Ability to navigate payer portals and CRM/field tools; strong communication/training skills.
- Analytical skills; ability to use data/reporting to manage caseload.
- Travel 50–70% within territory; valid driver’s license; industry credentialing.
- Proficiency: Outlook, Word, Excel, PowerPoint, Salesforce CRM.
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, and payer ecosystems; Medicare/Medicaid/commercial expertise.
Pay Range
- $136,000 - $204,000
Key Duties and Responsibilities
- Build compliant relationships with nephrology office personnel (care team and prior authorization/access administrators).
- Partner with case management to resolve escalated access issues and ensure coordinated handoffs (CRM triggers/workflows).
- Educate offices on copay, PAP, Bridge programs, and affordability pathways to support timely patient access.
- Follow up on case status and ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government prescription coverage requirements and payer trends.
- Conduct compliant on-site/virtual in-services and training on regional payer policies, formulary updates, PA/medical exception criteria, ICD-10/CPT coding and documentation, and distribution/hub/reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans and minimize patient-specific access barriers.
- Adhere to non-promotional guidelines; protect patient health information and follow all applicable laws/regulations and company policies.
Knowledge and Skills / Qualifications
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCP offices; strong payer investigation and PA/appeals/coverage knowledge.
- Ability to navigate payer portals and CRM/field tools; strong communication/training skills.
- Analytical skills; ability to use data/reporting to manage caseload.
- Travel 50–70% within territory; valid driver’s license; industry credentialing.
- Proficiency: Outlook, Word, Excel, PowerPoint, Salesforce CRM.
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, and payer ecosystems; Medicare/Medicaid/commercial expertise.
Pay Range
- $136,000 - $204,000