Field Reimbursement Manager - Kidney (Tri-State - NY, PA, NJ)
Vertex Pharmaceuticals
4 days ago
On-site
Pennsylvania, United States
Market Access
General Summary:
Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP). Serve as local subject matter expert to nephrology practices, providing non-promotional reimbursement/access education and troubleshooting to support timely patient access to prescribed Vertex kidney therapies.
Key Duties And Responsibilities:
- Build compliant relationships with nephrology office staff involved in prior authorizations and specialty medication access.
- 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/government coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, PA/exception criteria, ICD-10/CPT, distribution/hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts based on patient need and payer dynamics.
- Adhere to non-promotional/compliance/privacy guardrails; maintain patient confidentiality.
Knowledge And Skills (Required/Preferred):
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCP offices; navigate payer portals/CRM and field access tools.
- Strong training/communication, analytical skills, and use of data/reporting.
- Ability to travel 50–70%.
- Microsoft Office and Salesforce CRM proficiency.
Education And Experience:
- Bachelor’s degree in healthcare/life sciences/business (advanced degree a plus).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep understanding of PA, appeals, coverage policies, and benefits investigations; payer knowledge of Medicare/Medicaid/commercial.
Pay/Benefits:
- 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). Serve as local subject matter expert to nephrology practices, providing non-promotional reimbursement/access education and troubleshooting to support timely patient access to prescribed Vertex kidney therapies.
Key Duties And Responsibilities:
- Build compliant relationships with nephrology office staff involved in prior authorizations and specialty medication access.
- 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/government coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, PA/exception criteria, ICD-10/CPT, distribution/hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts based on patient need and payer dynamics.
- Adhere to non-promotional/compliance/privacy guardrails; maintain patient confidentiality.
Knowledge And Skills (Required/Preferred):
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCP offices; navigate payer portals/CRM and field access tools.
- Strong training/communication, analytical skills, and use of data/reporting.
- Ability to travel 50–70%.
- Microsoft Office and Salesforce CRM proficiency.
Education And Experience:
- Bachelor’s degree in healthcare/life sciences/business (advanced degree a plus).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep understanding of PA, appeals, coverage policies, and benefits investigations; payer knowledge of Medicare/Medicaid/commercial.
Pay/Benefits:
- Pay range: $136,000–$204,000. Eligible for annual bonus and annual equity awards.