Field Reimbursement Manager - Kidney (Atlanta, GA, SC)
Vertex Pharmaceuticals
June 27, 2026
On-site
South Carolina, United States
Market Access
Field Reimbursement Manager (Kidney Patient Support Program - KPSP)
Key Duties and Responsibilities
- Build compliant relationships with nephrology office personnel (care team and prior auth/patient access staff).
- Partner with case management to resolve escalated access issues; coordinate handoffs using CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways to support timely patient access.
- Follow up on case status and ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government insurance coverage requirements and payer trends.
- Deliver compliant on-site/virtual in-services and training on payer policies, formulary updates, coverage nuances, PA/medical exception criteria, ICD-10/CPT, documentation, distribution/hub services, enrollment, and reimbursement workflows.
- Manage a multistate territory, prioritize accounts based on patient need and payer dynamics, and develop local territory engagement plans.
- Adhere to strict non-promotional guidelines; maintain confidentiality and comply with laws, regulations, and company policies.
Knowledge and Skills
- Experience with specialty biologics/rare disease/compex pharmacy benefit products.
- Account management with HCPs/office staff; ability to navigate payer portals and CRM tools.
- Strong training, communication, relationship-building, analytical, and data/reporting skills.
- Ability to work in a fast-paced, results-driven environment; develop strategic account plans.
- Travel 50–70% within territory; proficiency in Microsoft Office and Salesforce CRM.
- Valid driver’s license; meet healthcare credentialing requirements.
Education and Experience
- Bachelor’s degree (health care/life sciences/business); advanced degree preferred.
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles.
- Deep understanding of benefits investigations, PA, appeals, coverage policies, and payer ecosystems.
Pay Range
- $136,000–$204,000; eligible for annual bonus and annual equity awards.
Key Duties and Responsibilities
- Build compliant relationships with nephrology office personnel (care team and prior auth/patient access staff).
- Partner with case management to resolve escalated access issues; coordinate handoffs using CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways to support timely patient access.
- Follow up on case status and ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government insurance coverage requirements and payer trends.
- Deliver compliant on-site/virtual in-services and training on payer policies, formulary updates, coverage nuances, PA/medical exception criteria, ICD-10/CPT, documentation, distribution/hub services, enrollment, and reimbursement workflows.
- Manage a multistate territory, prioritize accounts based on patient need and payer dynamics, and develop local territory engagement plans.
- Adhere to strict non-promotional guidelines; maintain confidentiality and comply with laws, regulations, and company policies.
Knowledge and Skills
- Experience with specialty biologics/rare disease/compex pharmacy benefit products.
- Account management with HCPs/office staff; ability to navigate payer portals and CRM tools.
- Strong training, communication, relationship-building, analytical, and data/reporting skills.
- Ability to work in a fast-paced, results-driven environment; develop strategic account plans.
- Travel 50–70% within territory; proficiency in Microsoft Office and Salesforce CRM.
- Valid driver’s license; meet healthcare credentialing requirements.
Education and Experience
- Bachelor’s degree (health care/life sciences/business); advanced degree preferred.
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles.
- Deep understanding of benefits investigations, PA, appeals, coverage policies, and payer ecosystems.
Pay Range
- $136,000–$204,000; eligible for annual bonus and annual equity awards.