Regional Access & Reimbursement Associate Director

Role Summary

The Regional Access and Reimbursement Associate Director will ensure appropriate access and reimbursement of Vertex cellular and genetic therapies within an assigned geography, in collaboration with US Market Access, Public Affairs, HEOR, Patient Support, and Sales/Marketing. The role builds relationships to enable patient access and resolve reimbursement challenges, and serves as the regional expert on reimbursement, coding, coverage, and payment. It develops and maintains regional/account business plans and provides insights on coding policy developments, reimbursement trends, contracting, and competitive activity. The role reports to the National Director of Access and Reimbursement. Location: Field Based, Southern and Southeast States.

Responsibilities

• Appropriately partners with internal stakeholders across functions (Payer Accounts, State Government Affairs, Trade and Distribution, Hospital Account Managers, Marketing, Patient Support) to develop and achieve targeted plans of action.
• Effectively manages objectives and priorities across multiple therapeutic areas.
• Collaborates closely with field payer teams on coverage policy developments and coding education.
• Develops and maintains geographic and account business plans.
• Establishes relationships with key institution/hospital personnel: C-Suite, Operations, Revenue Cycle Management, Finance, Managed Care, and other stakeholders responsible for access, coding, billing, reimbursement and overall financial clearance.
• Provides reimbursement-related support and education (Hospital Economics, Coding, Billing, Payment, Policy, Processes) to secure access for new procedures and therapies.
• Coordinates comprehensive reimbursement pull-through by proactively educating institution/hospital personnel on managed care and government payer coverage policies, billing and coding requirements, Medicare and State Medicaid reimbursement methodologies, prior Authorization and medical exception processes, claims submission and appeals processes, and Trade and Distribution.
• Ensures appropriate adoption and implementation of newly issued codes.
• Tracks all local payer billing, coding, and claims submission requirements.
• Leads cross-functional challenge resolution processes including interfacing with Patient Support as appropriate.
• Maintains compliance with Vertex SOPs and guidelines.

Qualifications

• Required: Typically requires 8 or more years of experience or the equivalent combination of education and experience.
• Preferred: Current experience in cell and gene therapy access and reimbursement.
• Preferred: Demonstrated experience in a field reimbursement or hospital administration role with demonstrated ability to problem solve reimbursement challenges within hospital/institution inpatient setting.

Skills

• Ability to perform in a fast-paced environment, manage multiple priorities simultaneously, and work effectively across functional teams.
• Excellent analytical, strategic thinking and communication skills.
• Expertise in the US market access environment across commercial payers, managed and fee-for-service segments of Medicaid/Medicare, Hospitals/health systems, benefit designs, coverage policies and reimbursement methodologies.
• Expertise in the inpatient hospital setting related to access and reimbursement requirements by department and overall hospital economics.
• Expertise in hospital financial and operational processes.

Education

• Bachelor’s degree in a relevant field (Required)
• Master’s/Advanced degree (Preferred)

Additional Requirements

• Travel: Overnight and weekend travel required; at least 80% within the assigned geography.