Field Reimbursement Manager - Kidney (South Texas)
Vertex Pharmaceuticals
4 days ago
On-site
Texas, United States
Market Access
General Summary:
- Field-based subject matter expert to nephrology practices providing non-promotional access and reimbursement education; troubleshoot access issues and provide territory-level payer expertise to support timely patient access to prescribed Vertex kidney therapies.
Key Duties And Responsibilities:
- Establish compliant relationships with nephrology office personnel (care team and administrative staff) to support prior authorization and patient access to specialty medications.
- Partner with case management to address escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways; provide timely case status follow-up and clarify insurance documentation requirements.
- Maintain knowledge of commercial and government prescription coverage requirements, payer trends, and access needs.
- Conduct on-site/virtual in-services and training on regional payer policies/formulary updates, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation requirements, and distribution/hub/reimbursement workflows.
- Independently manage a multi-state territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize patient-specific access barriers; adapt engagement to existing office workflows.
- Follow strict non-promotional guidelines, comply with laws/regulations/policies, and maintain confidentiality of patient health information.
Knowledge And Skills:
- Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCP/office staff.
- Ability to navigate payer portals, CRM systems, and field access tools; strong communication/training/relationship-building.
- Analytical skills using data/reporting tools to manage caseload and prioritize.
- Strategic business/account planning; sound judgment; results-driven; travel 50–70%.
- Proficient in Microsoft Outlook/Word/Excel/PowerPoint and Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education And Experience:
- Bachelor’s degree (health care, life sciences, or business); advanced degree is 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:
- Pay range: $136,000–$204,000 (plus annual bonus and annual equity; overtime may apply per law). Total Rewards include medical/dental/vision, paid time off (summer/winter shutdown), educational assistance/student loan repayment, commuting subsidy, charitable matching, and 401(k).
Application Instructions:
- If you need an accommodation during the hiring process or to perform essential functions, request via recruiter/hiring manager or contact Talent Acquisition at ApplicationAssistance@vrtx.com.
- Field-based subject matter expert to nephrology practices providing non-promotional access and reimbursement education; troubleshoot access issues and provide territory-level payer expertise to support timely patient access to prescribed Vertex kidney therapies.
Key Duties And Responsibilities:
- Establish compliant relationships with nephrology office personnel (care team and administrative staff) to support prior authorization and patient access to specialty medications.
- Partner with case management to address escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways; provide timely case status follow-up and clarify insurance documentation requirements.
- Maintain knowledge of commercial and government prescription coverage requirements, payer trends, and access needs.
- Conduct on-site/virtual in-services and training on regional payer policies/formulary updates, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation requirements, and distribution/hub/reimbursement workflows.
- Independently manage a multi-state territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize patient-specific access barriers; adapt engagement to existing office workflows.
- Follow strict non-promotional guidelines, comply with laws/regulations/policies, and maintain confidentiality of patient health information.
Knowledge And Skills:
- Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCP/office staff.
- Ability to navigate payer portals, CRM systems, and field access tools; strong communication/training/relationship-building.
- Analytical skills using data/reporting tools to manage caseload and prioritize.
- Strategic business/account planning; sound judgment; results-driven; travel 50–70%.
- Proficient in Microsoft Outlook/Word/Excel/PowerPoint and Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education And Experience:
- Bachelor’s degree (health care, life sciences, or business); advanced degree is 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:
- Pay range: $136,000–$204,000 (plus annual bonus and annual equity; overtime may apply per law). Total Rewards include medical/dental/vision, paid time off (summer/winter shutdown), educational assistance/student loan repayment, commuting subsidy, charitable matching, and 401(k).
Application Instructions:
- If you need an accommodation during the hiring process or to perform essential functions, request via recruiter/hiring manager or contact Talent Acquisition at ApplicationAssistance@vrtx.com.