Vertex Pharmaceuticals
Regional Access & Reimbursement Associate Director
Vertex Pharmaceuticals, Washington, District of Columbia, us, 20022
Regional Access & Reimbursement Associate Director
Vertex Pharmaceuticals is seeking a Regional Access & Reimbursement Associate Director to help ensure appropriate access and reimbursement of Vertex cellular and genetic therapies within an assigned geography, in collaboration with US Market Access functions, US Public Affairs, Field Health Economics Outcomes Research, Patient Support, Account Management, Sales, and Marketing colleagues. General Summary:
Vertex operates at the forefront of scientific innovation and has developed and commercialized breakthrough medicines for Cystic Fibrosis (CF), Pain, and gene therapies. Vertex has ongoing programs across several disease areas including Type 1 diabetes, APOL-1 Mediated Kidney Disease, IgA nephropathy, Duchenne Muscular Dystrophy, and Alpha-1 Antitrypsin Deficiency (AATD). Key Duties and Responsibilities Partner with internal stakeholders across Payer Accounts, State Government Affairs, Trade and Distribution, Hospital Account Managers, Marketing, and Patient Support to develop and execute 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 (C-Suite, Operations, Revenue Cycle Management, Finance, Managed Care, and others responsible for access, coding, billing, reimbursement, and financial clearance). Provide reimbursement-related support and education (Hospital Economics, Coding, Billing, Payment, Policy, Processes) to secure access for new procedures and therapies. Coordinate comprehensive reimbursement pull-through by educating institution/hospital personnel on: managed care and government payer coverage policies, billing and coding requirements, Medicare and State Medicaid reimbursement methodologies, prior authorization and medical exception processes, and claims submission/appeals. Engage with Trade and Distribution; ensure adoption and implementation of newly issued codes; track local payer billing, coding, and claims submission requirements. Lead cross-functional challenge resolution processes including interaction with Patient Support as appropriate. Travel overnight and on weekends as required to attend internal meetings and conferences; travel at least 60% within the assigned geography. Maintain compliance with Vertex SOPs and guidelines. Knowledge and Skills Ability to work in a fast-paced environment, manage multiple priorities, and collaborate 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. Experience with institution/hospital inpatient settings related to access and reimbursement requirements by department and hospital economics. Knowledge of hospital financial and operational processes. Education and Experience Bachelor’s degree in a relevant field required; Master’s/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 field reimbursement or hospital administration with ability to solve reimbursement challenges in inpatient settings. Location Field Based, Western States Pay Range $157,200 - $235,700 Disclosure Statement The base salary range is a reasonable estimate at the time of posting. This role is eligible for an annual bonus and annual equity awards. Overtime pay may be applicable where required by law. Actual base salary will be based on skills, competencies, experience, and other legally permitted factors. Vertex offers Total Rewards including comprehensive benefits, paid time off, educational assistance, commuting subsidy, 401(k), and more. Company Information & Equal Opportunity Vertex is a global biotechnology company focused on scientific innovation. Vertex is committed to equal employment opportunity and non-discrimination for all applicants regardless of race, color, sex, gender identity or expression, age, religion, national origin, ancestry, ethnicity, disability, veteran status, genetic information, sexual orientation, marital status, or any other protected characteristic. Vertex is an E-Verify employer in the United States. Reasonable accommodations will be provided for qualified individuals with known disabilities in accordance with applicable law. Applicants needing accommodations should contact the recruiter or Talent Acquisition at ApplicationAssistance@vrtx.com.
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Vertex Pharmaceuticals is seeking a Regional Access & Reimbursement Associate Director to help ensure appropriate access and reimbursement of Vertex cellular and genetic therapies within an assigned geography, in collaboration with US Market Access functions, US Public Affairs, Field Health Economics Outcomes Research, Patient Support, Account Management, Sales, and Marketing colleagues. General Summary:
Vertex operates at the forefront of scientific innovation and has developed and commercialized breakthrough medicines for Cystic Fibrosis (CF), Pain, and gene therapies. Vertex has ongoing programs across several disease areas including Type 1 diabetes, APOL-1 Mediated Kidney Disease, IgA nephropathy, Duchenne Muscular Dystrophy, and Alpha-1 Antitrypsin Deficiency (AATD). Key Duties and Responsibilities Partner with internal stakeholders across Payer Accounts, State Government Affairs, Trade and Distribution, Hospital Account Managers, Marketing, and Patient Support to develop and execute 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 (C-Suite, Operations, Revenue Cycle Management, Finance, Managed Care, and others responsible for access, coding, billing, reimbursement, and financial clearance). Provide reimbursement-related support and education (Hospital Economics, Coding, Billing, Payment, Policy, Processes) to secure access for new procedures and therapies. Coordinate comprehensive reimbursement pull-through by educating institution/hospital personnel on: managed care and government payer coverage policies, billing and coding requirements, Medicare and State Medicaid reimbursement methodologies, prior authorization and medical exception processes, and claims submission/appeals. Engage with Trade and Distribution; ensure adoption and implementation of newly issued codes; track local payer billing, coding, and claims submission requirements. Lead cross-functional challenge resolution processes including interaction with Patient Support as appropriate. Travel overnight and on weekends as required to attend internal meetings and conferences; travel at least 60% within the assigned geography. Maintain compliance with Vertex SOPs and guidelines. Knowledge and Skills Ability to work in a fast-paced environment, manage multiple priorities, and collaborate 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. Experience with institution/hospital inpatient settings related to access and reimbursement requirements by department and hospital economics. Knowledge of hospital financial and operational processes. Education and Experience Bachelor’s degree in a relevant field required; Master’s/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 field reimbursement or hospital administration with ability to solve reimbursement challenges in inpatient settings. Location Field Based, Western States Pay Range $157,200 - $235,700 Disclosure Statement The base salary range is a reasonable estimate at the time of posting. This role is eligible for an annual bonus and annual equity awards. Overtime pay may be applicable where required by law. Actual base salary will be based on skills, competencies, experience, and other legally permitted factors. Vertex offers Total Rewards including comprehensive benefits, paid time off, educational assistance, commuting subsidy, 401(k), and more. Company Information & Equal Opportunity Vertex is a global biotechnology company focused on scientific innovation. Vertex is committed to equal employment opportunity and non-discrimination for all applicants regardless of race, color, sex, gender identity or expression, age, religion, national origin, ancestry, ethnicity, disability, veteran status, genetic information, sexual orientation, marital status, or any other protected characteristic. Vertex is an E-Verify employer in the United States. Reasonable accommodations will be provided for qualified individuals with known disabilities in accordance with applicable law. Applicants needing accommodations should contact the recruiter or Talent Acquisition at ApplicationAssistance@vrtx.com.
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