Field Reimbursement Manager - Kidney (Tri-State - NY, PA, NJ)
Vertex Pharmaceuticals
4 days ago
On-site
New Jersey, 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 with non-promotional access and reimbursement education.
- Support timely patient access to prescribed Vertex kidney therapies through troubleshooting and territory-level payer expertise.
Key Duties And Responsibilities:
- Build compliant relationships with nephrology office care team and administrative staff for prior authorizations and patient access.
- Partner with case management on escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways.
- Follow up on case status and ensure offices understand insurance documentation requirements.
- Maintain understanding of commercial and government insurance coverage requirements and payer trends.
- Deliver compliant on-site/virtual in-services and training on payer policies/formulary updates, PA/medical exception criteria, ICD-10/CPT/coding and documentation, and distribution/hub/reimbursement workflows.
- Manage a multistate region; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize access barriers.
- Follow non-promotional guidelines and program business rules; maintain patient confidentiality and compliance.
Knowledge And Skills:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCPs/office staff; navigate payer portals, CRM systems, and field access tools.
- Strong communication/training/relationship-building, analytical, and data/reporting skills.
- Develop and execute strategic account plans; exercise sound judgment.
- Travel 50–70%; proficiency in Outlook/Word/Excel/PowerPoint/Salesforce CRM; valid driver’s license; meet credentialing requirements.
Education And Experience:
- Bachelor’s degree (health care, life sciences, or business); advanced degree is a plus.
- 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 payer ecosystems.
- In-depth knowledge of Medicare, Medicaid, and commercial plans.
Pay Range:
- $136,000 - $204,000
Benefits:
- Eligible for annual bonus and annual equity awards. (Additional benefits listed.)
Application Instructions:
- For application assistance: 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 with non-promotional access and reimbursement education.
- Support timely patient access to prescribed Vertex kidney therapies through troubleshooting and territory-level payer expertise.
Key Duties And Responsibilities:
- Build compliant relationships with nephrology office care team and administrative staff for prior authorizations and patient access.
- Partner with case management on escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways.
- Follow up on case status and ensure offices understand insurance documentation requirements.
- Maintain understanding of commercial and government insurance coverage requirements and payer trends.
- Deliver compliant on-site/virtual in-services and training on payer policies/formulary updates, PA/medical exception criteria, ICD-10/CPT/coding and documentation, and distribution/hub/reimbursement workflows.
- Manage a multistate region; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize access barriers.
- Follow non-promotional guidelines and program business rules; maintain patient confidentiality and compliance.
Knowledge And Skills:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCPs/office staff; navigate payer portals, CRM systems, and field access tools.
- Strong communication/training/relationship-building, analytical, and data/reporting skills.
- Develop and execute strategic account plans; exercise sound judgment.
- Travel 50–70%; proficiency in Outlook/Word/Excel/PowerPoint/Salesforce CRM; valid driver’s license; meet credentialing requirements.
Education And Experience:
- Bachelor’s degree (health care, life sciences, or business); advanced degree is a plus.
- 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 payer ecosystems.
- In-depth knowledge of Medicare, Medicaid, and commercial plans.
Pay Range:
- $136,000 - $204,000
Benefits:
- Eligible for annual bonus and annual equity awards. (Additional benefits listed.)
Application Instructions:
- For application assistance: ApplicationAssistance@vrtx.com