Field Reimbursement Manager - Kidney (South Florida)
Vertex Pharmaceuticals
3 months ago
On-site
Florida, United States
Market Access
General Summary:
Field-based Field Reimbursement Manager for Vertex Kidney Patient Support Program (KPSP), serving as local subject matter expert to nephrology practices with non-promotional access and reimbursement education; troubleshoot access issues and provide territory-level payer expertise to support timely patient access.
Key Duties And Responsibilities:
- Compliantly establish connections with nephrology office staff (care team and authorization/patient access administrators) to support patient access.
- Partner with case management to address escalated access issues; coordinate handoffs via CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways; ensure offices understand documentation requirements.
- Maintain knowledge of commercial and government prescription coverage and payer trends.
- Conduct compliant on-site and virtual in-services/trainings on payer policies/formulary updates, PA/medical exceptions, coding/billing (ICD-10, CPT), documentation, distribution/hub/enrollment/reimbursement workflows.
- Independently manage a multistate region; prioritize accounts by patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize access barriers; adhere to strict non-promotional guidelines and maintain patient health information confidentiality.
Knowledge And Skills:
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCPs/office staff.
- Navigate payer portals/CRM and field access tools; strong communication/training/relationship-building.
- Analytical skills; use data/reporting tools to manage caseload/prioritize.
- Experience developing/executing strategic account plans; judgment/problem-solving.
- Travel 50–70% within territory; proficiency in Outlook/Word/Excel/PowerPoint/Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education And Experience:
- Bachelor’s degree (health care/life sciences/business); advanced degree preferred.
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field access.
- Deep understanding of benefits investigations, PA processes, appeals, coverage policies; knowledge of Medicare/Medicaid/commercial.
Pay Range: $136,000 - $204,000 (eligible for annual bonus and annual equity awards).
Application Instructions: Contact recruiter/hiring manager for accommodations during hiring; Talent Acquisition: ApplicationAssistance@vrtx.com.
Field-based Field Reimbursement Manager for Vertex Kidney Patient Support Program (KPSP), serving as local subject matter expert to nephrology practices with non-promotional access and reimbursement education; troubleshoot access issues and provide territory-level payer expertise to support timely patient access.
Key Duties And Responsibilities:
- Compliantly establish connections with nephrology office staff (care team and authorization/patient access administrators) to support patient access.
- Partner with case management to address escalated access issues; coordinate handoffs via CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways; ensure offices understand documentation requirements.
- Maintain knowledge of commercial and government prescription coverage and payer trends.
- Conduct compliant on-site and virtual in-services/trainings on payer policies/formulary updates, PA/medical exceptions, coding/billing (ICD-10, CPT), documentation, distribution/hub/enrollment/reimbursement workflows.
- Independently manage a multistate region; prioritize accounts by patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize access barriers; adhere to strict non-promotional guidelines and maintain patient health information confidentiality.
Knowledge And Skills:
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCPs/office staff.
- Navigate payer portals/CRM and field access tools; strong communication/training/relationship-building.
- Analytical skills; use data/reporting tools to manage caseload/prioritize.
- Experience developing/executing strategic account plans; judgment/problem-solving.
- Travel 50–70% within territory; proficiency in Outlook/Word/Excel/PowerPoint/Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education And Experience:
- Bachelor’s degree (health care/life sciences/business); advanced degree preferred.
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field access.
- Deep understanding of benefits investigations, PA processes, appeals, coverage policies; knowledge of Medicare/Medicaid/commercial.
Pay Range: $136,000 - $204,000 (eligible for annual bonus and annual equity awards).
Application Instructions: Contact recruiter/hiring manager for accommodations during hiring; Talent Acquisition: ApplicationAssistance@vrtx.com.