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 serves as the state/regional expert on reimbursement (coding, coverage, payment) and develops maintains in-depth regional/account business plans with insights on coding, payer coverage policy developments, reimbursement, contracting trends, and competitive activity.

Responsibilities

• Appropriately partners with internal stakeholders across functions 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 responsible for access, coding, billing, reimbursement and financial clearance.
• Provides reimbursement-related support and education to secure access for new procedures and therapies.
• Coordinates reimbursement pull-through by educating institution/hospital personnel on policies, billing/coding requirements, Medicare/State Medicaid reimbursement methodologies, prior authorization, claims submission, and appeals processes.
• Engages with Trade and Distribution; ensures adoption and implementation of newly issued codes; tracks local payer billing, coding, and claims submission requirements.
• Leads cross-functional challenge resolution processes including interfacing with Patient Support as appropriate.
• Travel: overnight and weekend travel required; 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, and work effectively across functional teams.
• Excellent analytical, strategic thinking and communication skills.
• Expertise in the US market access environment across Commercial Payers, Medicaid/Medicare, Hospitals/health systems, benefit designs, coverage policies and reimbursement methodologies.
• Expertise in institution/hospital inpatient setting related to access and reimbursement requirements by department and hospital economics.
• Expertise in hospital financial and operational processes.

Education

• Bachelor‚Äôs degree in relevant field required; Master‚Äôs/Advanced degree preferred.
• Current experience in cell and gene therapy access and reimbursement preferred.
• Experience in field reimbursement or hospital administration with problem solving reimbursement challenges in hospital/institution inpatient setting.

Location

• Field Based, Southern and Southeast States