Field Reimbursement Manager - Kidney (Southeast - AL, GA, FL)
Vertex Pharmaceuticals
4 days ago
On-site
Georgia, 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. Provide non-promotional access and reimbursement education, troubleshoot to support timely patient access, and use territory-level payer expertise.
Key Duties And Responsibilities:
- Compliantly build connections with nephrology office care teams and administrative staff (prior authorizations/patient access) to support prescribed medication access.
- Partner with case management on escalated access issues; use CRM triggers/workflows for coordinated handoffs.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways; provide timely follow-up on case status and insurance documentation requirements.
- Maintain understanding of commercial/government prescription coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies/formulary updates, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation, distribution pathways/hub services/enrollment, and reimbursement workflows.
- Independently manage a multistate region; develop territory engagement plans; tailor engagement to office workflows.
- Follow non-promotional guidelines and comply with laws/regulations and confidentiality requirements.
Knowledge And Skills (Qualifications):
- Specialty biologics/rare disease/complex PBM experience; account management with HCP offices.
- Ability to navigate payer portals/CRM and field access tools; strong communication/training/relationship and analytical skills; leverage data/reporting to prioritize caseload.
- Travel 50–70%; proficiency: Outlook, Word, Excel, PowerPoint, Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing.
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-based access.
- Deep understanding of benefits investigations, PA processes, appeals, coverage policies; knowledge of Medicare/Medicaid/commercial plans.
Pay Range:
- $136,000 - $204,000
Application:
- As part of the hiring process, contact the recruiter/hiring manager; accommodation requests may be sent to ApplicationAssistance@vrtx.com.
- Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP), serving as a local subject matter expert to nephrology practices. Provide non-promotional access and reimbursement education, troubleshoot to support timely patient access, and use territory-level payer expertise.
Key Duties And Responsibilities:
- Compliantly build connections with nephrology office care teams and administrative staff (prior authorizations/patient access) to support prescribed medication access.
- Partner with case management on escalated access issues; use CRM triggers/workflows for coordinated handoffs.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways; provide timely follow-up on case status and insurance documentation requirements.
- Maintain understanding of commercial/government prescription coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies/formulary updates, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation, distribution pathways/hub services/enrollment, and reimbursement workflows.
- Independently manage a multistate region; develop territory engagement plans; tailor engagement to office workflows.
- Follow non-promotional guidelines and comply with laws/regulations and confidentiality requirements.
Knowledge And Skills (Qualifications):
- Specialty biologics/rare disease/complex PBM experience; account management with HCP offices.
- Ability to navigate payer portals/CRM and field access tools; strong communication/training/relationship and analytical skills; leverage data/reporting to prioritize caseload.
- Travel 50–70%; proficiency: Outlook, Word, Excel, PowerPoint, Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing.
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-based access.
- Deep understanding of benefits investigations, PA processes, appeals, coverage policies; knowledge of Medicare/Medicaid/commercial plans.
Pay Range:
- $136,000 - $204,000
Application:
- As part of the hiring process, contact the recruiter/hiring manager; accommodation requests may be sent to ApplicationAssistance@vrtx.com.