Vertex
Biotechnology
FieldReimbursementManager-Kidney(GreatPlains-NV,UT,CO,NE,KS)
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“Field Reimbursement Manager - Kidney (Great Plains - NV, UT, CO, NE, KS) at Vertex. Skills: Reimbursement education, Patient access, Payer knowledge. Establish connections with key nephrology office personnel. Support patient access to prescribed medications”
Industry & Context.
Troubleshooting; Problem solving
50-70% travel, Safe driving requirements, Credentialing requirements
What They're Looking For.
Must Have
5+ years experience, Bachelor’s degree in health care, Valid driver's license
Nice to Have
Advanced degree in business, Advanced degree in healthcare, Advanced degree in social services
What You'll Do.
Establish connections with key nephrology office personnel
Support patient access to prescribed medications
Partner with case management team
Address escalated access
Ensure coordinated handoffs
Educate offices on copay
Educate offices on PAP
Educate offices on Bridge programs
Educate offices on affordability pathways
Provide timely follow-up on case status
Ensure offices understand insurance documentation requirements
Maintain understanding of commercial insurance coverage
Maintain understanding of government insurance coverage
Conduct on-site in-services
Conduct virtual in-services
Deliver education on regional payer policies
Deliver education on formulary updates
Deliver education on coverage nuances
Deliver education on PA criteria
Deliver education on medical exception criteria
Deliver education on coding
Deliver education on billing
Deliver education on documentation requirements
Deliver education on distribution pathways
Deliver education on hub services
Deliver education on enrollment processes
Deliver education on reimbursement workflows
Conduct on-site training
Conduct virtual training
Manage a multistate geographic region
Prioritize accounts based on patient need
Prioritize accounts based on payer dynamics
Prioritize accounts based on KPSP demand
Adapt engagement with HCP offices
Develop territory engagement plans
Minimize patient-specific access barriers
Adhere to non-promotional engagements
Maintain confidentiality of patient health information
Act in compliance with laws
Act in compliance with regulations
Act in compliance with Vertex company policies
Apply program business rules
Apply work instructions
How You'll Work.
Team & Collaboration
Provider office staff; Internal PSP teams; Vendor teams
Communication Scope
Training; Relationship-building
Full Job Description
**Job Description** **General Summary:** Vertex is currently building a field reimbursement team to support our upcoming journey to advance, develop, and deliver therapies to those living with serious kidney diseases. We are preparing for potential commercialization of investigational therapeutics being studied for the treatment of Immunoglobulin A nephropathy (IgAN), additional B cell-mediated diseases, and other genetic kidney diseases. We are seeking a dedicated and collaborative Field Reimbursement Manager to join our Kidney Patient Support Program (KPSP). In this field-based role, you will serve as the local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education. You will also support timely access for patients to prescribed Vertex kidney therapies through effective troubleshooting and territory-level payer expertise. **Key Duties and Responsibilities:** * Compliantly establish strong connections with key nephrology office personnel, including members of the care team and administrative staff responsible for prior authorizations and patient access to specialty medications, to support patient access to prescribed medications. * Partner with case management team to address escalated access issues; ensure coordinated handoffs using CRM triggers and workflows. * Support timely patient access to their prescribed Vertex medicine by educating offices on copay, PAP, Bridge programs, and other affordability pathways. * Provide timely follow-up on case status and ensure offices understand insurance documentation requirements. * Maintain a comprehensive understanding of commercial and government prescription insurance coverage requirements for access and payer trends. * Conduct on-site and virtual in-services to deliver compliant and comprehensive education on: * Regional payer policies, formulary updates, and coverage nuances. * PA/medical exception criteria, coding/billing (ICD‑10, CPT), and documentation requirements
Applying for this Field Reimbursement Manager - Kidney (Great Plains - NV, UT, CO, NE, KS) role?
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