Field Reimbursement Liaison

Vertex Inc.

1d • $136,000 - $204,000

About The Position

The Field Reimbursement Liaison (FRL) provides access and reimbursement assistance to optimize the patient experience with assigned products. Regionally based, the FRL coordinates a cross-functional team to help ensure patients can access treatment. The role works with healthcare professionals and their ancillary staff, nurse case managers, HUB coordinators, the Market Access team, and channel partners on complex access and reimbursement cases. It provides education about company-sponsored patient programs and guidance on processes related to prior authorizations, resubmissions, and denials.

Candidates are strongly preferred to live within the assigned territory to support timely, consistent engagement with healthcare providers, patient access stakeholders, and key accounts. The position involves regional travel across potentially large, multi-state territories, including overnight travel two to three nights per week and travel up to 75%. A car allowance is provided for driving to assigned targets.

Requirements

• Bachelor’s degree and at least 12 years of experience in healthcare and/or the pharmaceutical or biotechnology industry.
• Clinical, technical, and scientific knowledge and aptitude in complex or rare diseases.
• Strong written and verbal communication, organizational, and interpersonal skills.
• Ability to build credibility and use persuasion effectively to achieve desired results.
• Knowledge of third-party payers, including Medicare, Medicaid, and commercial payers, and case management processes such as prior authorization and appeals.
• Technical aptitude, proficiency using an iPad, and working proficiency with Microsoft Word, Excel, PowerPoint, and Outlook.
• Effective time management, resource allocation, and workload management skills.
• Comfort with ambiguity and ability to adapt continuously.
• Responsiveness and a sense of urgency.
• Ability to balance strategic and analytical thinking with tactical execution.
• Functional and cross-functional teamwork experience.
• Ability to work independently.
• Must live within the territory or its assigned boundaries.
• Ability to travel regionally and cover large, multi-state territories, including overnight travel two to three nights per week and travel up to 75%.
• Valid driver's license and clean driving record.
• Ability to drive an automobile to assigned targets within the territory.

Nice To Haves

• At least 3–5 years of access and reimbursement experience.
• Experience with case management and Customer Relationship Management (CRM) systems.
• At least two years of experience working with specialty pharmacy networks.
• Strong understanding of U.S. healthcare policy and payment systems, including hospital and physician reimbursement.
• Working knowledge of CPT, ICD-10, and HCPCS coding and site-of-care reimbursement, including infusion sites, physician offices, and hospital outpatient departments.
• Experience launching a new specialty pharmaceutical or biologic product, or a new product indication.

Responsibilities

• Conduct office calls with healthcare professionals and/or office staff to support appropriate patient access to company products, including help resolving reimbursement, patient program, and coverage questions.
• Resolve patient coverage, access, and reimbursement issues in coordination with patient services and in accordance with policy.
• Communicate patient services programs, policies, procedures, and resources so office staff can effectively use sponsored programs and systems.
• Liaise with the Patient Support Center and network specialty pharmacies.
• Provide strategic coverage and reimbursement leadership and support to the internal Sales team.
• Recommend and implement process improvements to enhance the patient experience.
• Serve as a subject matter expert on reimbursement and access, including payer policies, prior authorization requirements, denials, appeals, peer-to-peer processes, and related education.
• Provide insights and updates on product and support-service integration at healthcare provider and hospital pharmacy accounts.
• Conduct quarterly practice reviews of patient services utilization to help improve offerings to patients.
• Create training materials and deliver education to sales personnel, physicians, pharmacy directors, billing personnel, and other internal and external stakeholders as needed.
• Monitor customer and market access industry trends and analyze access and reimbursement issues and opportunities.
• Maintain a thorough understanding of company policies and requirements, and perform responsibilities consistently with company guidance.
• Handle protected health information appropriately.

Benefits

• Annual bonus eligibility
• Annual equity awards
• Medical, dental, and vision benefits
• Generous paid time off, including a week-long company shutdown in the summer and winter
• Educational assistance programs, including student loan repayment
• Commuting subsidy
• Matching charitable donations
• 401(k)
• Car allowance

What This Job Offers

• Job Type: Full-time
• Career Level: Senior