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 through education and within an assigned geography in close collaboration with other US Market Access functions, US Public Affairs, Field Health Economics Outcomes Research, Patient Support, Account Management/sales and Marketing colleagues. The individual will proactively build customer relationships within a geography to help ensure patient access to therapies and resolution of potential customer reimbursement challenges. This role shall serve as the state/regional expert on reimbursement (coding, coverage, payment). This role develops and maintains in-depth regional/account business plans and provides timely insights on coding, payer coverage policy developments, reimbursement, contracting trends, and competitive activity.

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 engaging with institution/hospital personnel to educate 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
• 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
• Requires overnight and weekend travel to attend internal meetings, conferences and at least 60% within assigned geography
• Maintains compliance with Vertex SOPs and guidelines

Knowledge

• 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 institution/hospital inpatient setting related to access and reimbursement requirements by department and overall hospital economics
• Expertise in hospital financial and operational processes

Education and Experience

• Bachelor‚Äôs degree in relevant field required; Master‚Äôs/Advanced degree preferred
• Typically requires 8 or more years of experience or the 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 demonstrated ability to problem solve reimbursement challenges within Hospital/Institution inpatient setting

Location

• Field Based, Southern and Southeast States