Regional Access & Reimbursement Associate Director

Role Summary

Regional Access & Reimbursement Associate Director will help ensure appropriate access and reimbursement of Vertex cellular and genetic therapies through education within an assigned geography in close collaboration with US Market Access functions and colleagues. Serves as the state/regional expert on reimbursement (coding, coverage, payment) and develops regional/account business plans, providing insights on coding, payer coverage policy developments, reimbursement, contracting trends, and competitive activity. Reports to National Director of Access and Reimbursement.

Responsibilities

• Partner with internal stakeholders across functions to develop and achieve targeted plans of action.
• Manage objectives and priorities across multiple therapeutic areas.
• Collaborate with field payer teams on coverage policy developments and coding education.
• Develop and maintain geographic and account business plans.
• Establish relationships with key institution/hospital personnel responsible for access, coding, billing, reimbursement and financial clearance.
• Provide reimbursement-related support and education to secure access for new procedures and therapies.
• Coordinate comprehensive reimbursement pull-through by educating institution/hospital personnel on managed care, billing and coding requirements, Medicare/State Medicaid reimbursement methodologies, prior authorization, claims submission and appeals.
• Engage with Trade and Distribution; ensure adoption and implementation of newly issued codes; track local payer requirements.
• Lead cross-functional challenge resolution processes, interfacing with Patient Support as appropriate.
• Travel overnight and weekends as needed to attend internal meetings and conferences, at least 60% within assigned geography.
• Maintain compliance with Vertex SOPs and guidelines.

Knowledge

• Ability to perform in a fast-paced environment, manage multiple priorities, and work across functional teams.
• Analytical, strategic thinking and communication skills.
• Expertise in US market access across payers, Medicaid/Medicare, hospitals/health systems, and reimbursement methodologies.
• Understanding of hospital inpatient access and reimbursement requirements and hospital economics.
• Knowledge of hospital financial and operational processes.

Education

• Bachelor‚Äôs degree in a relevant field required; Master‚Äôs/Advanced degree preferred.
• Typically 8+ years of experience or equivalent combination of education and experience.
• Current experience in cell and gene therapy access and reimbursement preferred.
• Experience in field reimbursement or hospital administration with ability to address reimbursement challenges in inpatient settings.

Location

• Field Based, Southern and Southeast States