Field Reimbursement Manager - Kidney (Atlanta, GA, SC)
Vertex Pharmaceuticals
June 27, 2026
On-site
Alabama, United States
Market Access
General Summary:
Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP), serving as a local subject matter expert to nephrology practices. Provide non-promotional access and reimbursement education, troubleshoot to support timely patient access, and use territory-level payer expertise.
Key Duties and Responsibilities:
- Establish compliant relationships with nephrology office personnel to support prior authorizations and patient access to specialty medications.
- Partner with case management to address escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways.
- Provide follow-up on case status; ensure offices understand insurance documentation requirements.
- Maintain understanding of commercial and government coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, formulary updates, coverage nuances, PA/medical exception criteria, ICD-10/CPT, documentation, distribution pathways, hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate region; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize patient access barriers.
- Follow strict non-promotional guidelines; maintain confidentiality of patient health information and comply with all laws/regulations/company policies.
Knowledge and Skills:
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCP offices.
- Navigate payer portals, CRM systems, and field access tools.
- Strong communication, training, and relationship-building; analytical and data/reporting skills.
- Ability to work in a fast-paced, results-driven environment; develop/exeute strategic account plans.
- Travel 50–70% within territory; Microsoft Outlook/Word/Excel/PowerPoint/Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education and Experience:
- Bachelor’s degree (health care, life sciences, or business); advanced degree a plus.
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep understanding of benefits investigations, PA/appeals, coverage policies, and payer ecosystems; knowledge of Medicare/Medicaid/commercial.
Pay Range:
$136,000–$204,000; eligible for annual bonus and annual equity awards.
Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP), serving as a local subject matter expert to nephrology practices. Provide non-promotional access and reimbursement education, troubleshoot to support timely patient access, and use territory-level payer expertise.
Key Duties and Responsibilities:
- Establish compliant relationships with nephrology office personnel to support prior authorizations and patient access to specialty medications.
- Partner with case management to address escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways.
- Provide follow-up on case status; ensure offices understand insurance documentation requirements.
- Maintain understanding of commercial and government coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, formulary updates, coverage nuances, PA/medical exception criteria, ICD-10/CPT, documentation, distribution pathways, hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate region; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize patient access barriers.
- Follow strict non-promotional guidelines; maintain confidentiality of patient health information and comply with all laws/regulations/company policies.
Knowledge and Skills:
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCP offices.
- Navigate payer portals, CRM systems, and field access tools.
- Strong communication, training, and relationship-building; analytical and data/reporting skills.
- Ability to work in a fast-paced, results-driven environment; develop/exeute strategic account plans.
- Travel 50–70% within territory; Microsoft Outlook/Word/Excel/PowerPoint/Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education and Experience:
- Bachelor’s degree (health care, life sciences, or business); advanced degree a plus.
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep understanding of benefits investigations, PA/appeals, coverage policies, and payer ecosystems; knowledge of Medicare/Medicaid/commercial.
Pay Range:
$136,000–$204,000; eligible for annual bonus and annual equity awards.