Senior Patient Support Specialist

Job Description

General Summary:

The Senior Patient Support Specialist (SPSS) provides personalized support for cystic fibrosis patients, leading engagements with healthcare providers (HCPs) from CF center care teams, vendor partners, and Specialty Pharmacies.  The SPSS applies commercial and government reimbursement expertise to counsel HCPs and patients on coverage requirements and acts as the subject-matter-expert in supporting patients through access and reimbursement challenges

Key Duties and Responsibilities:

• Reimbursement & Access: (60%)

• Develops and maintains a strategic business plan for supporting their CF patients; utilizes analytics tools to proactively monitor medication schedules and anticipate patient needs to rapidly respond to trends
• Leverages insurance, access, and reimbursement expertise to counsel patients and HCPs on coverage and SP requirements
• Manages multiple complex access and reimbursement challenges to completion in a time-sensitive, fast-paced environment
• Effectively escalates access, vendor, and pharmacy challenges, keeping appropriate stakeholders informed
• Maintains a comprehensive understanding of commercial and government prescription insurance coverage requirements for access and payer trends
• Assesses patient eligibility for Vertex financial assistance programs including copay and patient assistance programs; advises on complex and sensitive financial circumstances

• Adherence & Education: (25%)

• Sustains knowledge of approved CFTR (Cystic Fibrosis Transmembrane Conductance Regulator) modulator treatments and supplemental assistance programs to provide exceptional patient support
• Anticipates and pursues opportunities throughout the treatment journey to provide Vertex treatment education and resources to mitigate adherence barriers
• Maintains strong working relationships with external partners including HCPs, HUB vendor, Specialty Distributors, and Specialty Pharmacies to maintain/increase adherence rates
• Maintains patient records and interactions in CRM; provides refill reminders and scheduling support to patients; ensuring delivery, management, and monitoring of the treatment refill process
• Maintains confidentiality of patient health information and acts in compliance with all laws, regulations, and Vertex Company policies.
• Strategic planning & advancing GPS team capabilities: (15%)
• Creates a culture of compliant cross-functional collaboration, serving as a business partner to internal Vertex stakeholders such as sales and field reimbursement teams
• Interacts with sales, marketing, patient advocacy, payer teams, information technology and similar teams to provide excellent patient journey experience

Knowledge and Skills:

• Experience in payer reimbursement (including benefit investigations, interpreting summary of benefits and coverage insurance documentation,  prior authorizations, and appeals)
• Experience in patient support and/or case management (Pharmaceutical or biotechnology preferred)
• Working knowledge of healthcare compliance and regulatory environment
• Excellent verbal and written communication skills
• High level of empathy, experience navigating difficult conversations
• Ability to facilitate appropriate judgment in decision making and solve difficult and complex problems
• Capability to work independently with limited supervision, self-prioritize workload, and demonstrate high level of agility

Education and Experience:

• Bachelor's degree
• Typically requires 3-4+ years of experience or the equivalent combination of education and experience
• Experience working with the Cystic Fibrosis or other rare disease communities
• Commercial and government payer reimbursement experience
• Patient support and case management experience that includes communication with clinical care tea

Other Requirements:

• Proficiency in Microsoft Outlook, Word, Excel, Power Point, Salesforce CRM or similar
• Ability to travel up to 15%, including evenings and weekends as needed
• While the Company is usually closed on holidays, employees may be asked on occasion to work in order to meet organizational needs
• Experience applying Motivational Interviewing techniques (preferred)
• Medical interpreter certification (optional)
• Fluency in Spanish (optional)

Pay Range:

Disclosure Statement:

The range provided is based on what we believe is a reasonable estimate for the base salary pay range for this job at the time of posting. This role is eligible for an annual bonus and annual equity awards. Some roles may also be eligible for overtime pay, in accordance with federal and state requirements. Actual base salary pay will be based on a number of factors, including skills, competencies, experience, and other job-related factors permitted by law.

At Vertex, our Total Rewards offerings also include inclusive market-leading benefits to meet our employees wherever they are in their career, financial, family and wellbeing journey while providing flexibility and resources to support their growth and aspirations.  From medical, dental and vision benefits to generous paid time off (including a week-long company shutdown in the Summer and the Winter), educational assistance programs including student loan repayment, a generous commuting subsidy, matching charitable donations, 401(k) and so much more.

Flex Designation:

Flex Eligibility Status:

In this Hybrid-Eligible role, you can choose to be designated as: 
1.    Hybrid: work remotely up to two days per week; or select
2.    On-Site: work five days per week on-site with ad hoc flexibility.

Note: The Flex status for this position is subject to Vertex's Policy on Flex @ Vertex Program and may be changed at any time. 

#LI-Hybrid
 

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