Field Reimbursement Manager - Kidney (Atlanta, GA, SC)
Vertex Pharmaceuticals
June 27, 2026
On-site
United States
Market Access
Field Reimbursement Manager (Kidney Patient Support Program – KPSP)
Key Duties and Responsibilities
- Build compliant relationships with nephrology office staff to support prior authorization and patient access.
- Partner with case management to resolve escalated access issues; use CRM triggers/workflows for handoffs.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways to enable timely access.
- Follow up on case status and ensure understanding of insurance documentation requirements.
- Maintain knowledge of commercial and government coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation, distribution pathways, hub services, enrollment, and reimbursement workflows.
- Manage a multistate territory; prioritize accounts by patient need, payer dynamics, and KPSP demand.
- Adhere to non-promotional guidelines; ensure compliance with legal/compliance/privacy requirements; maintain patient confidentiality.
Knowledge and Skills
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCPs.
- Ability to navigate payer portals/CRM and field access tools.
- Strong communication, training, relationship-building, analytical, and data/reporting skills.
- Strategic business/account planning; sound judgment in problem solving.
- Travel 50–70%; Microsoft Outlook/Word/Excel/PowerPoint/Salesforce CRM.
- Valid driver’s license and ability to meet credentialing requirements.
Education and Experience
- Bachelor’s degree (health care, life sciences, or business); advanced degree preferred.
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep knowledge of benefits investigations, PA processes, appeals, coverage policies; payer knowledge (Medicare, Medicaid, commercial).
Pay Range
- $136,000–$204,000
Key Duties and Responsibilities
- Build compliant relationships with nephrology office staff to support prior authorization and patient access.
- Partner with case management to resolve escalated access issues; use CRM triggers/workflows for handoffs.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways to enable timely access.
- Follow up on case status and ensure understanding of insurance documentation requirements.
- Maintain knowledge of commercial and government coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation, distribution pathways, hub services, enrollment, and reimbursement workflows.
- Manage a multistate territory; prioritize accounts by patient need, payer dynamics, and KPSP demand.
- Adhere to non-promotional guidelines; ensure compliance with legal/compliance/privacy requirements; maintain patient confidentiality.
Knowledge and Skills
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCPs.
- Ability to navigate payer portals/CRM and field access tools.
- Strong communication, training, relationship-building, analytical, and data/reporting skills.
- Strategic business/account planning; sound judgment in problem solving.
- Travel 50–70%; Microsoft Outlook/Word/Excel/PowerPoint/Salesforce CRM.
- Valid driver’s license and ability to meet credentialing requirements.
Education and Experience
- Bachelor’s degree (health care, life sciences, or business); advanced degree preferred.
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep knowledge of benefits investigations, PA processes, appeals, coverage policies; payer knowledge (Medicare, Medicaid, commercial).
Pay Range
- $136,000–$204,000