Field Reimbursement Manager - Kidney (Southern California - San Diego and Anaheim)
Vertex Pharmaceuticals
3 days ago
On-site
California, United States
Market Access
Key Duties and Responsibilities:
- Build compliant connections with nephrology practice staff (care team and prior authorization/patient access administrators) to support access to prescribed specialty medications.
- Partner with case management to resolve escalated access issues and coordinate handoffs via CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways; follow up on case status and documentation needs.
- Maintain knowledge of commercial and government insurance coverage requirements and payer trends.
- Deliver compliant on-site/virtual in-services and training on payer policies, formularies, PA/medical exception criteria, ICD-10/CPT coding, documentation, distribution pathways, hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize patient-specific access barriers; adhere to strict non-promotional and confidentiality requirements.
Knowledge and Skills:
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCPs/office staff.
- Ability to navigate payer portals and CRM/field access tools; strong training/relationship-building, analytical, and data/reporting skills.
- Comfort in fast-paced, results-driven environment; experience creating strategic account plans; sound judgment.
- Travel 50–70% within territory; MS Outlook/Word/Excel/PowerPoint; Salesforce CRM.
- Valid driver’s license; meet healthcare industry credentialing requirements.
Education and Experience:
- Bachelor’s degree (health care, life sciences, or 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/appeals, coverage policies, and Medicare/Medicaid/commercial.
Compensation/Benefits:
- Pay range: $136,000–$204,000. Eligible for annual bonus and annual equity awards; may be eligible for overtime (as applicable).
- Build compliant connections with nephrology practice staff (care team and prior authorization/patient access administrators) to support access to prescribed specialty medications.
- Partner with case management to resolve escalated access issues and coordinate handoffs via CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways; follow up on case status and documentation needs.
- Maintain knowledge of commercial and government insurance coverage requirements and payer trends.
- Deliver compliant on-site/virtual in-services and training on payer policies, formularies, PA/medical exception criteria, ICD-10/CPT coding, documentation, distribution pathways, hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize patient-specific access barriers; adhere to strict non-promotional and confidentiality requirements.
Knowledge and Skills:
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCPs/office staff.
- Ability to navigate payer portals and CRM/field access tools; strong training/relationship-building, analytical, and data/reporting skills.
- Comfort in fast-paced, results-driven environment; experience creating strategic account plans; sound judgment.
- Travel 50–70% within territory; MS Outlook/Word/Excel/PowerPoint; Salesforce CRM.
- Valid driver’s license; meet healthcare industry credentialing requirements.
Education and Experience:
- Bachelor’s degree (health care, life sciences, or 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/appeals, coverage policies, and Medicare/Medicaid/commercial.
Compensation/Benefits:
- Pay range: $136,000–$204,000. Eligible for annual bonus and annual equity awards; may be eligible for overtime (as applicable).