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Vertex · 1 day ago

Regional Access & Reimbursement Associate Director

North Carolina - Field Based

Full-time

Hybrid

Senior Level, Lead/Staff

$160K/yr - $240K/yr

8+ years exp

Vertex is a global biotechnology company that invests in scientific innovation. The Regional Access and Reimbursement Associate Director will help ensure appropriate access and reimbursement of Vertex cellular and genetic therapies through education and collaboration with various stakeholders.

Computer Software

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

Qualification

US market access expertiseReimbursement methodologiesHospital financial processesCellGene therapy experienceStrategic thinkingAnalytical skillsCommunication skillsProblem-solvingCollaboration

Required

Bachelor's degree in relevant field required

Typically requires 8 or more years of experience or the equivalent combination of education and experience

Demonstrated experience in a field reimbursement or hospital administration role with demonstrated ability to problem solve reimbursement challenges within Hospital/Institution inpatient setting

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