Vertex
Biotechnology
FieldReimbursementManager-Kidney(SouthCentral-AR,MS,LA,TN)
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“Field Reimbursement Manager - Kidney (South Central - AR, MS, LA, TN) at Vertex. Skills: Reimbursement education, Patient access, Payer policies. Establish connections with key nephrology office personnel. Support patient access to prescribed medications”
Industry & Context.
Troubleshooting; Decision making
Ability to travel 50-70%, Meet credentialing requirements
What They're Looking For.
Must Have
Minimum 5+ years’ experience in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles, Deep understanding of benefits investigations, PA processes, appeals, coverage policies, and payer ecosystems, Payer knowledge and in-depth understanding of Medicare, Medicaid, and commercial insurance plans, Valid driver's license, Ability to meet safe driving requirements, Ability to satisfy and meet all health care industry representative credentialing requirements
Nice to Have
Advanced degree in business, healthcare, social services is a plus
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 issues
Ensure coordinated handoffs
Educate offices on copay
Support timely patient access
Provide timely follow-up on case status
Ensure offices understand insurance documentation requirements
Maintain understanding of commercial and government prescription insurance
Maintain understanding of payer trends
Conduct on-site and virtual in-services
Deliver compliant and comprehensive education on regional payer
Deliver education on formulary updates
Deliver education on coverage nuances
Deliver education on PA/medical exception criteria
Deliver education on coding/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 and virtual training
Use approved payer guides
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 prescribing HCP offices
Develop territory engagement plans
Minimize patient-specific access barriers
Adhere to strict non-promotional guidelines
Maintain confidentiality of patient health information
Act in compliance with all laws
Apply program business rules
Apply work instructions
Deliver consistent and compliant patient experience
Deliver compliant customer experience
How You'll Work.
Team & Collaboration
Internal PSP teams; Vendor teams
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 (South Central - AR, MS, LA, TN) role?
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