Field Reimbursement Manager - Kidney (Capitol - WV, VA, MD)
Vertex Pharmaceuticals
June 27, 2026
On-site
West Virginia, United States
Market Access
General Summary:
Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP). Serve as local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education, troubleshooting for timely patient access, and applying territory-level payer expertise.
Key Duties And Responsibilities:
- Build compliant relationships with nephrology office personnel involved in prior authorizations and specialty medication access.
- Partner with case management to address escalated access issues; coordinate handoffs via CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways; ensure offices meet insurance documentation requirements.
- Maintain knowledge of commercial and government prescription coverage requirements, payer trends, and PA/medical exception criteria.
- Conduct on-site/virtual in-services and training on payer policies, formulary updates, coverage nuances; coding/billing (ICD-10, CPT) and documentation; distribution/hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans; adhere to strict non-promotional guidelines; maintain patient confidentiality.
Knowledge And Skills:
- Experience with specialty biologics/rare disease or complex pharmacy benefit products.
- Account management with HCP offices; ability to navigate payer portals, CRM systems, and field tools.
- Strong communication/training/relationship-building, analytical and data/reporting skills.
- Strategic business/account planning; good judgment.
- Travel 50–70%; Microsoft Office (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 roles.
- Deep understanding of benefits investigations, PA/appeals, and coverage policies.
- Knowledge of Medicare, Medicaid, and commercial insurance.
Pay/Benefits:
- Pay range: $136,000–$204,000; eligible for annual bonus and annual equity awards.
Application Instructions:
- Apply via the hiring process; request accommodation through a recruiter or hiring manager (or Talent Acquisition at ApplicationAssistance@vrtx.com).
Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP). Serve as local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education, troubleshooting for timely patient access, and applying territory-level payer expertise.
Key Duties And Responsibilities:
- Build compliant relationships with nephrology office personnel involved in prior authorizations and specialty medication access.
- Partner with case management to address escalated access issues; coordinate handoffs via CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways; ensure offices meet insurance documentation requirements.
- Maintain knowledge of commercial and government prescription coverage requirements, payer trends, and PA/medical exception criteria.
- Conduct on-site/virtual in-services and training on payer policies, formulary updates, coverage nuances; coding/billing (ICD-10, CPT) and documentation; distribution/hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans; adhere to strict non-promotional guidelines; maintain patient confidentiality.
Knowledge And Skills:
- Experience with specialty biologics/rare disease or complex pharmacy benefit products.
- Account management with HCP offices; ability to navigate payer portals, CRM systems, and field tools.
- Strong communication/training/relationship-building, analytical and data/reporting skills.
- Strategic business/account planning; good judgment.
- Travel 50–70%; Microsoft Office (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 roles.
- Deep understanding of benefits investigations, PA/appeals, and coverage policies.
- Knowledge of Medicare, Medicaid, and commercial insurance.
Pay/Benefits:
- Pay range: $136,000–$204,000; eligible for annual bonus and annual equity awards.
Application Instructions:
- Apply via the hiring process; request accommodation through a recruiter or hiring manager (or Talent Acquisition at ApplicationAssistance@vrtx.com).