Field Reimbursement Manager - Kidney (Southeast - AL, GA, FL)
Vertex Pharmaceuticals
11 hours ago
On-site
Florida, United States
Market Access
General Summary:
Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP), serving as a local subject-matter expert to nephrology practices to provide non-promotional reimbursement/access education and troubleshoot to support timely patient access.
Key Duties & Responsibilities:
- Build compliant relationships with nephrology office personnel involved in prior authorizations and patient access.
- Partner with case management on escalated access issues; use CRM triggers/workflows for handoffs.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways.
- Follow up on case status and ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government insurance coverage requirements and payer trends.
- Conduct compliant on-site/virtual in-services covering payer policies, PA/medical exception criteria, ICD-10/CPT, documentation, distribution/hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts based on patient need and payer dynamics.
- Develop territory engagement plans to minimize access barriers; follow strict non-promotional guidelines and maintain patient confidentiality.
Knowledge & Skills:
- Specialty biologics/rare disease or complex pharmacy benefit experience; account management.
- Ability to navigate payer portals and CRM/tools; strong communication/training and analytical skills; data/reporting to manage caseload.
- Strategic account planning; sound judgment; travel 50–70%.
- Proficiency: Outlook/Word/Excel/PowerPoint/Salesforce.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education & Experience:
- Bachelor’s degree (health care/life sciences/business). Minimum 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep understanding of benefits investigations, PA/appeals, coverage policies; payer knowledge (Medicare/Medicaid/commercial).
Pay Range:
$136,000–$204,000 (eligible for annual bonus and annual equity awards).
Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP), serving as a local subject-matter expert to nephrology practices to provide non-promotional reimbursement/access education and troubleshoot to support timely patient access.
Key Duties & Responsibilities:
- Build compliant relationships with nephrology office personnel involved in prior authorizations and patient access.
- Partner with case management on escalated access issues; use CRM triggers/workflows for handoffs.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways.
- Follow up on case status and ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government insurance coverage requirements and payer trends.
- Conduct compliant on-site/virtual in-services covering payer policies, PA/medical exception criteria, ICD-10/CPT, documentation, distribution/hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts based on patient need and payer dynamics.
- Develop territory engagement plans to minimize access barriers; follow strict non-promotional guidelines and maintain patient confidentiality.
Knowledge & Skills:
- Specialty biologics/rare disease or complex pharmacy benefit experience; account management.
- Ability to navigate payer portals and CRM/tools; strong communication/training and analytical skills; data/reporting to manage caseload.
- Strategic account planning; sound judgment; travel 50–70%.
- Proficiency: Outlook/Word/Excel/PowerPoint/Salesforce.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education & Experience:
- Bachelor’s degree (health care/life sciences/business). Minimum 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep understanding of benefits investigations, PA/appeals, coverage policies; payer knowledge (Medicare/Medicaid/commercial).
Pay Range:
$136,000–$204,000 (eligible for annual bonus and annual equity awards).