Field Reimbursement Manager - Kidney (Atlanta, GA, SC)
Vertex Pharmaceuticals
June 27, 2026
On-site
Georgia, United States
Market Access
Field Reimbursement Manager (Kidney Patient Support Program)
Key Duties and Responsibilities
- Establish compliant connections with nephrology office personnel (care team and administrative staff) to support 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 to support timely patient access.
- Provide timely follow-up on case status; ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government prescription coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on regional payer policies, formulary updates, coverage nuances, PA/medical exception criteria, ICD-10/CPT coding, documentation requirements, distribution pathways, hub services, enrollment processes, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Adapt engagement to existing HCP office workflows; avoid inefficiencies.
- Develop territory engagement plans to minimize patient-specific access barriers.
- Adhere to non-promotional guidelines and maintain confidentiality of patient health information; comply with laws/regulations and company policies.
Knowledge and Skills
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCP offices; navigate payer portals/CRM/field tools.
- Strong communication/training/relationship-building; analytical and data/reporting skills.
- Ability to develop and execute strategic business/account plans; sound judgment.
- Travel 50–70% in assigned territory; Microsoft Office and Salesforce CRM.
- Valid driver’s license and ability to meet credentialing requirements.
Education and Experience
- Bachelor’s degree in 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 roles.
- Deep understanding of benefits investigations, PA processes, appeals, coverage policies, and payer ecosystems.
- Knowledge of Medicare, Medicaid, and commercial insurance plans.
Pay Range: $136,000 - $204,000
Key Duties and Responsibilities
- Establish compliant connections with nephrology office personnel (care team and administrative staff) to support 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 to support timely patient access.
- Provide timely follow-up on case status; ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government prescription coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on regional payer policies, formulary updates, coverage nuances, PA/medical exception criteria, ICD-10/CPT coding, documentation requirements, distribution pathways, hub services, enrollment processes, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Adapt engagement to existing HCP office workflows; avoid inefficiencies.
- Develop territory engagement plans to minimize patient-specific access barriers.
- Adhere to non-promotional guidelines and maintain confidentiality of patient health information; comply with laws/regulations and company policies.
Knowledge and Skills
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCP offices; navigate payer portals/CRM/field tools.
- Strong communication/training/relationship-building; analytical and data/reporting skills.
- Ability to develop and execute strategic business/account plans; sound judgment.
- Travel 50–70% in assigned territory; Microsoft Office and Salesforce CRM.
- Valid driver’s license and ability to meet credentialing requirements.
Education and Experience
- Bachelor’s degree in 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 roles.
- Deep understanding of benefits investigations, PA processes, appeals, coverage policies, and payer ecosystems.
- Knowledge of Medicare, Medicaid, and commercial insurance plans.
Pay Range: $136,000 - $204,000