Field Reimbursement Liaison

Job Description

General Summary:

The Field Reimbursement Liaison (FRL) provides access & reimbursement assistance to optimize the patient experience with assigned products.  The FRL is regionally based and coordinates a cross-functional team in ensuring patients have access to treatment. The FRL interfaces with healthcare professionals, including their ancillary staff, nurse case managers (NCMs), HUB coordinators, Market Access team, and various Channel Partners on complex access and reimbursement cases by providing education on company’s sponsored patient programs and process guidance in response to prior authorizations, resubmissions, and denials. 

Candidates are strongly preferred to reside within assigned territory, to support timely and consistent engagement with healthcare providers, patient access stakeholders, and key accounts across this high priority territory.

Essential Job Functions and Responsibilities: 

These may include but are not limited to:

• Conduct office calls with HCPs and/or office staff for support with appropriate patient access to Company’s products, including assistance in resolving reimbursement, patient programs, and coverage questions.
• Resolve issues associated with patient coverage, access, and reimbursement in collaboration and coordination with patient services as directed by policy.
• Proactively communicate Company’s patient services programs, policies, procedures, and resources so that office staff (i.e., practice manager, nursing, billing, and reimbursement staff) are fluent in how to use our sponsored programs and systems.
• Liaise with Patient Support Center and our network Specialty Pharmacies.
• Provide strategic coverage/reimbursement leadership and support to the internal Sales team.
• Recommend and implement process improvement updates/changes to improve the patient experience.
• Serve as the subject matter expert on the reimbursement / access landscape, including payer policies, prior authorization requirements, denials, appeals, peer to peer, and other education required to navigate access.
• Provide insights and updates regarding product and support service integration at HCP and Hospital Pharmacy accounts.
• Conduct quarterly reviews with practices on their utilization of Companies patient services to better enhance our offerings to patients.
• Create training materials and deliver education programs to sales force, physicians, pharmacy directors, billing personnel, and other internal and external stakeholders as needed.
• Keep abreast of customer and market access industry trends; analyze access/reimbursement issues and opportunities. 
• Maintain a deep understanding of Companies policies and requirements and perform all responsibilities in a manner consistent with company guidance.
• Handle PHI appropriately.

Education and Experience:
Required:

• Bachelor’s degree required with a minimum of 12 years’ experience in healthcare and/or pharmaceutical/biotech industry.
• Clinical, technical, and scientific knowledge and aptitude in complex/rare diseases.
• Strong communication, organizational, and interpersonal skills (both written and verbal).
• Ability to gain high levels of credibility and excellent persuasion skills to achieve desired results.
• Knowledge of third-party payers (Medicare, Medicaid, commercial) and case management process (prior authorization and appeals).
• Demonstrated technical aptitude and working proficiency in using iPad and working proficiency in Microsoft Word, Excel, PowerPoint, and Outlook.
• Effective time management, resources allocation, and workload management.
• Comfort with ambiguity and the ability to adapt continuously.
• Demonstrated responsiveness and a sense of urgency.
• Ability to balance strategic thinking/analytical analysis with tactical execution.
• Functional and cross-functional teamwork experience.
• Ability to work independently.
• Must live within territory or within territory boundaries assigned for the position.

Preferred:

• At least 3-5 years of access and reimbursement experience.
• Case management and Customer Relationship Management (CRM) systems experience.
• Minimum of 2 years’ experience working with specialty pharmacy networks.
• Strong understanding of US health care policy and payment systems, including hospital and physician reimbursement.
• Working knowledge of CPT, ICD-10, HCPCS coding; site of care reimbursement environment (infusion site, physician office, HOPD reimbursement).
• Experience in launching a new specialty pharmaceutical/biologic product or new product indication.

Physical Demands and Work Environment:
Physical Activities: On a continuous basis, sit at desk for a long period of time; intermittently answer telephone and write or use a keyboard to communicate through written means. Some walking and lifting up to 25 lbs. may be required. The noise level in the work environment is typically low to moderate. The physical demands described above are representative of those that must be met by an employee to successfully perform the essential functions and responsibilities of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions and responsibilities.

Travel and Role Related Areas

• Ability to travel regionally and cover large multi-state territories
• Must reside in the region; relocation assistance is not provided
• Ability to travel to work related meetings and ability to travel overnight for 2-3 nights per week
• Ability to travel up to 75%
• A valid driver's license and clean driving record
• Ability to drive to assigned targets within the territory via an automobile (a car allowance is provided)

At Vertex, we embrace continuous learning and encourage employees to stay informed on advances in AI, technology, automation, and industry trends. We seek talent who bring an external perspective, demonstrate curiosity and sound judgment, and thoughtfully adopt new capabilities that improve decision-making, drive innovation, increase efficiency, and help deliver better outcomes for patients.

Pay Range:

Disclosure Statement:

Company Information

Vertex is a global biotechnology company that invests in scientific innovation.

Vertex is committed to equal employment opportunity and non-discrimination for all employees and qualified applicants without regard to a person's race, color, sex, gender identity or expression, age, religion, national origin, ancestry, ethnicity, disability, veteran status, genetic information, sexual orientation, marital status, or any characteristic protected under applicable law. Vertex is an E-Verify Employer in the United States. Vertex will make reasonable accommodations for qualified individuals with known disabilities, in accordance with applicable law.

Any applicant requiring an accommodation in connection with the hiring process and/or to perform the essential functions of the position for which the applicant has applied should make a request to the recruiter or hiring manager, or contact Talent Acquisition at ApplicationAssistance@vrtx.com