Regional Access & Reimbursement Associate Director

Role Summary

Regional Access & Reimbursement Associate Director at Vertex. Responsible for ensuring appropriate access and reimbursement of Vertex cellular and genetic therapies within an assigned geography, in collaboration with US Market Access, US Public Affairs, Field HEOR, Patient Support, Account Management/Sales, and Marketing. Serves as the state/regional expert on reimbursement (coding, coverage, payment) and develops in-depth regional/account business plans with insights on coding, payer 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 policies, billing and coding requirements, Medicare/State Medicaid reimbursement methodologies, prior authorization processes, and claims submission/appeals.
• Maintain tracking of local payer billing, coding, and claims submission requirements.
• Lead cross-functional challenge resolution processes with Patient Support as appropriate.
• Travel overnight and on weekends to attend internal meetings and conferences, with at least 60% travel within assigned geography.
• Maintain compliance with Vertex SOPs and guidelines.

Qualifications

• 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 a field reimbursement or hospital administration role with ability to solve reimbursement challenges in Hospital/Institution inpatient settings.

Location

• Field Based, Southern and Southeast States

Skills

• Ability to perform in a fast-paced environment, manage multiple priorities, and work effectively across functional teams.
• Excellent analytical, strategic thinking, and communication skills.
• Expertise in US market access environment across Commercial Payers, Medicaid/Medicare, hospitals/health systems, benefit designs, coverage policies, and reimbursement methodologies.
• Expertise in hospital inpatient access and reimbursement requirements by department and hospital economics.
• Expertise in hospital financial and operational processes.