Field Reimbursement Manager - Kidney (South Texas)
Vertex Pharmaceuticals
3 days ago
On-site
United States
Market Access
General Summary:
- Field-based Field Reimbursement Manager for Kidney Patient Support Program (KPSP), serving as local subject matter expert to nephrology practices to provide non-promotional access and reimbursement education; troubleshoot to support timely patient access.
Key Duties And Responsibilities:
- Build compliant relationships with nephrology care team and authorization/patient access staff to support access to specialty medications.
- Partner with case management to resolve escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways; provide follow-up on case status and insurance documentation requirements.
- Maintain knowledge of commercial and government prescription insurance coverage, payer trends, PA/medical exception criteria, coding/billing (ICD-10, CPT), and documentation.
- Deliver compliant on-site/virtual in-services and training on payer policies, formulary updates, coverage nuances, distribution pathways, hub services, enrollment, and reimbursement workflows using approved guides/tools.
- Independently manage a multistate territory; create territory engagement plans to minimize access barriers; tailor engagement to office workflows.
- Follow strict non-promotional and confidentiality requirements; apply program business rules for consistent compliant patient/customer experience.
Knowledge And Skills:
- Specialty biologics/rare disease/complex PB products; account management; navigate payer portals/CRM/tools; strong communication/training/analytics; data/reporting to manage caseload; strategic account planning; judgment/problem-solving.
- Travel 50–70%; MS Outlook/Word/Excel/PowerPoint/Salesforce; valid driver’s license; meet credentialing for facilities.
Education And Experience:
- Bachelor’s in health care/life sciences/business (advanced degree plus); 5+ years in sales/reimbursement/market access/specialty pharmacy/patient services/field access; deep understanding of benefits investigations, PA, appeals, coverage policies; payer knowledge of Medicare/Medicaid/commercial.
Pay Range: $136,000 - $204,000
Annual bonus and annual equity awards; other pay/benefits may apply per job listing.
Application instructions: Contact recruiter or hiring manager for accommodation requests; Talent Acquisition: ApplicationAssistance@vrtx.com.
- Field-based Field Reimbursement Manager for Kidney Patient Support Program (KPSP), serving as local subject matter expert to nephrology practices to provide non-promotional access and reimbursement education; troubleshoot to support timely patient access.
Key Duties And Responsibilities:
- Build compliant relationships with nephrology care team and authorization/patient access staff to support access to specialty medications.
- Partner with case management to resolve escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways; provide follow-up on case status and insurance documentation requirements.
- Maintain knowledge of commercial and government prescription insurance coverage, payer trends, PA/medical exception criteria, coding/billing (ICD-10, CPT), and documentation.
- Deliver compliant on-site/virtual in-services and training on payer policies, formulary updates, coverage nuances, distribution pathways, hub services, enrollment, and reimbursement workflows using approved guides/tools.
- Independently manage a multistate territory; create territory engagement plans to minimize access barriers; tailor engagement to office workflows.
- Follow strict non-promotional and confidentiality requirements; apply program business rules for consistent compliant patient/customer experience.
Knowledge And Skills:
- Specialty biologics/rare disease/complex PB products; account management; navigate payer portals/CRM/tools; strong communication/training/analytics; data/reporting to manage caseload; strategic account planning; judgment/problem-solving.
- Travel 50–70%; MS Outlook/Word/Excel/PowerPoint/Salesforce; valid driver’s license; meet credentialing for facilities.
Education And Experience:
- Bachelor’s in health care/life sciences/business (advanced degree plus); 5+ years in sales/reimbursement/market access/specialty pharmacy/patient services/field access; deep understanding of benefits investigations, PA, appeals, coverage policies; payer knowledge of Medicare/Medicaid/commercial.
Pay Range: $136,000 - $204,000
Annual bonus and annual equity awards; other pay/benefits may apply per job listing.
Application instructions: Contact recruiter or hiring manager for accommodation requests; Talent Acquisition: ApplicationAssistance@vrtx.com.