Regional Access & Reimbursement Associate Director

Vertex Inc.

1d•Onsite

About The Position

Vertex currently operates at the forefront of scientific innovation and has successfully developed and commercialized multiple breakthrough medicines for Cystic Fibrosis (CF), Pain, and the first CRISPR-based, gene therapy for sickle cell disease and transfusion-dependent beta thalassemia. In addition to clinical development programs in CF, Vertex has more than a dozen ongoing research programs focused on the underlying mechanisms of other serious diseases including programs in Type 1 diabetes, APOL-1 Mediated Kidney Disease, IgA nephropathy, Duchenne Muscular Dystrophy, and Alpha-1 Antitrypsin Deficiency (AATD). 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 shall serve as the state/regional expert on reimbursement (coding, coverage, payment). This role develops and maintains in-depth regional/account business plans and provides timely insights on coding, payer coverage policy developments, reimbursement, contracting trends, and competitive activity. This position reports to National Director of Access and Reimbursement.

Requirements

Ability to perform in a fast-paced environment, manage multiple priorities simultaneously, and work effectively across functional teams
Excellent analytical, strategic thinking and communication skills
Expertise in the US market access environment across Commercial Payers, managed and fee-for-service segments of Medicaid/Medicare, Hospitals/health systems, benefit designs, coverage policies and reimbursement methodologies
Expertise in the institution/hospital inpatient setting related to access and reimbursement requirements by department and overall hospital economics
Expertise in hospital financial and operational processes
Bachelor’s degree in relevant field required; Master’s/Advanced degree preferred
Typically requires 8 or more years of experience or the equivalent combination of education and experience
Current experience in cell and gene therapy access and reimbursement preferred
Demonstrated experience in a field reimbursement or hospital administration role with demonstrated ability to problem solve reimbursement challenges within Hospital/Institution inpatient setting

Responsibilities

Appropriately partners with internal stakeholders across functions (Payer Accounts, State Government Affairs, Trade and Distribution, Hospital Account Managers, Marketing, Patient Support) 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: C-Suite, Operations, Revenue Cycle Management, Finance, Managed Care, and other stakeholders responsible for access, coding, billing, reimbursement and overall financial clearance
Provides reimbursement-related support and education (Hospital Economics, Coding, Billing, Payment, Policy, Processes) to secure access for new procedures and therapies.
Coordinates comprehensive reimbursement pull-through by proactively engaging with institution/hospital personnel to educate on:
Managed care and government payer coverage policies
Billing and coding requirements
Medicare and State Medicaid reimbursement methodologies
Prior Authorization and medical exception processes
Claims submission and appeals processes
Trade and Distribution
Ensures appropriate adoption and implementation of newly issued codes
Tracks all local payer billing, coding, and claims submission requirements
Leads cross-functional challenge resolution processes including interfacing with Patient Support as appropriate
Requires overnight and weekend travel to attend internal meetings, conferences and at least 80% within assigned geography
Maintains compliance with Vertex SOPs and guidelines