Field Reimbursement Manager - Kidney (Southeast - AL, GA, FL)
Vertex Pharmaceuticals
4 days ago
On-site
Alabama, United States
Market Access
General Summary:
Field-based Field Reimbursement Manager (Kidney Patient Support Program, KPSP) serving as local subject matter expert to nephrology practices, providing compliant reimbursement/access education and troubleshooting to support timely patient access to prescribed therapies.
Key Duties And Responsibilities:
- Establish compliant connections with nephrology office personnel (care team and authorization/patient access staff).
- Partner with case management to address escalated access issues; coordinate handoffs via CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways.
- Follow up on case status and ensure understanding of insurance documentation requirements.
- Maintain knowledge of commercial and government insurance coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, PA/medical exception criteria, ICD-10/CPT coding, documentation, and reimbursement workflows.
- Manage a multistate territory; develop territory engagement plans to minimize access barriers.
- Adhere to strict non-promotional guidelines; maintain patient confidentiality and compliance with applicable laws/policies.
Knowledge And Skills (Selected):
- Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCP offices.
- Ability to navigate payer portals and CRM/tools; strong training/relationship-building and analytical skills.
- Travel 50–70% within territory; proficiency with MS Office and Salesforce CRM.
Education And Experience:
- Bachelor’s degree in health care/life sciences/business (advanced degree a plus).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field access.
- Deep understanding of benefits investigations, PA/appeals, coverage policies, and Medicare/Medicaid/commercial.
Pay Range:
$136,000–$204,000. Eligible for annual bonus and annual equity awards.
Field-based Field Reimbursement Manager (Kidney Patient Support Program, KPSP) serving as local subject matter expert to nephrology practices, providing compliant reimbursement/access education and troubleshooting to support timely patient access to prescribed therapies.
Key Duties And Responsibilities:
- Establish compliant connections with nephrology office personnel (care team and authorization/patient access staff).
- Partner with case management to address escalated access issues; coordinate handoffs via CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways.
- Follow up on case status and ensure understanding of insurance documentation requirements.
- Maintain knowledge of commercial and government insurance coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, PA/medical exception criteria, ICD-10/CPT coding, documentation, and reimbursement workflows.
- Manage a multistate territory; develop territory engagement plans to minimize access barriers.
- Adhere to strict non-promotional guidelines; maintain patient confidentiality and compliance with applicable laws/policies.
Knowledge And Skills (Selected):
- Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCP offices.
- Ability to navigate payer portals and CRM/tools; strong training/relationship-building and analytical skills.
- Travel 50–70% within territory; proficiency with MS Office and Salesforce CRM.
Education And Experience:
- Bachelor’s degree in health care/life sciences/business (advanced degree a plus).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field access.
- Deep understanding of benefits investigations, PA/appeals, coverage policies, and Medicare/Medicaid/commercial.
Pay Range:
$136,000–$204,000. Eligible for annual bonus and annual equity awards.