Regional Access & Reimbursement Associate Director
Vertex Pharmaceuticals
5 hours ago
On-site
Field Pointe, MD
$160,000 - $240,000 USD yearly
Market Access
Key Duties And Responsibilities:
- Partner 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.
- 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 (C-Suite, Operations, Revenue Cycle Management, Finance, Managed Care, and other stakeholders) responsible for access, coding, billing, reimbursement, and financial clearance.
- Provide reimbursement-related support and education (Hospital Economics, Coding, Billing, Payment, Policy, Processes) to secure access for new procedures and therapies.
- Coordinate reimbursement pull-through by educating on managed care/government coverage policies, billing/coding requirements, Medicare and State Medicaid reimbursement methodologies, prior authorization and medical exception processes, and claims submission/appeals processes.
- Ensure appropriate adoption and implementation of newly issued codes.
- Track local payer billing, coding, and claims submission requirements.
- Lead cross-functional challenge resolution processes, interfacing with Patient Support as appropriate.
- Travel overnight/weekends; at least 80% within 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 US market access (Commercial Payers; managed and fee-for-service Medicaid/Medicare; hospitals/health systems; benefit designs; coverage policies; reimbursement methodologies).
- Expertise in the institution/hospital inpatient setting for access and reimbursement requirements and hospital economics.
- Expertise in hospital financial and operational processes.
Education And Experience:
- Bachelor’s degree in relevant field required; Master’s/Advanced degree preferred.
- Typically requires 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 the inpatient setting.
Location:
- Field Based, Southern and Southeast States.
- Partner 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.
- 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 (C-Suite, Operations, Revenue Cycle Management, Finance, Managed Care, and other stakeholders) responsible for access, coding, billing, reimbursement, and financial clearance.
- Provide reimbursement-related support and education (Hospital Economics, Coding, Billing, Payment, Policy, Processes) to secure access for new procedures and therapies.
- Coordinate reimbursement pull-through by educating on managed care/government coverage policies, billing/coding requirements, Medicare and State Medicaid reimbursement methodologies, prior authorization and medical exception processes, and claims submission/appeals processes.
- Ensure appropriate adoption and implementation of newly issued codes.
- Track local payer billing, coding, and claims submission requirements.
- Lead cross-functional challenge resolution processes, interfacing with Patient Support as appropriate.
- Travel overnight/weekends; at least 80% within 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 US market access (Commercial Payers; managed and fee-for-service Medicaid/Medicare; hospitals/health systems; benefit designs; coverage policies; reimbursement methodologies).
- Expertise in the institution/hospital inpatient setting for access and reimbursement requirements and hospital economics.
- Expertise in hospital financial and operational processes.
Education And Experience:
- Bachelor’s degree in relevant field required; Master’s/Advanced degree preferred.
- Typically requires 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 the inpatient setting.
Location:
- Field Based, Southern and Southeast States.