Regional Access & Reimbursement Associate Director

Role Summary

The Regional Access and Reimbursement Associate Director will help ensure appropriate access and reimbursement of Vertex cellular and genetic therapies within an assigned geography in collaboration with US Market Access functions and other colleagues. The role 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.

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 and government payer policies, billing and coding requirements, Medicare/State Medicaid reimbursement methodologies, prior authorization, medical exceptions, and claims processes.
• Track local payer billing, coding, and claims submission requirements.
• Lead cross-functional challenge resolution processes, interfacing with Patient Support as appropriate.
• Travel overnight and on weekends as required, with at least 60% within the assigned geography.
• Maintain compliance with Vertex SOPs and guidelines.

Knowledge and Skills

• Ability to work in a fast-paced environment, manage multiple priorities, and collaborate across teams.
• Excellent analytical, strategic thinking, and communication skills.
• Expertise in the US market access environment across payer types, hospitals/health systems, benefit designs, and reimbursement methodologies.
• Expertise in inpatient hospital access and reimbursement requirements by department and hospital economics.
• Experience with hospital financial and operational processes.

Education and Experience

• 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.
• Demonstrated experience in field reimbursement or hospital administration with ability to solve reimbursement challenges in inpatient settings.

Location

• Field Based, Southern and Southeast States