Field Reimbursement Manager - Kidney (Capitol - WV, VA, MD)
Vertex Pharmaceuticals
June 27, 2026
On-site
Virginia, United States
Market Access
General Summary:
- Field-based Field Reimbursement Manager for Vertex Kidney Patient Support Program (KPSP), serving as local subject matter expert to nephrology practices by providing non-promotional access and reimbursement education, and supporting timely patient access through troubleshooting and payer expertise.
Responsibilities:
- Build compliant relationships with nephrology care teams and office staff involved in prior authorizations and specialty medication access.
- Partner with case management to resolve escalated access issues and ensure coordinated CRM handoffs.
- Educate offices on copay/PAP/Bridge programs and other affordability pathways.
- Follow up on case status and ensure offices meet insurance documentation requirements.
- Maintain understanding of commercial and government insurance requirements and payer trends.
- Deliver compliant on-site/virtual in-services and training on payer policies, PA/medical exception criteria, coding/billing (ICD-10, CPT), distribution/hub workflows, enrollment, and access tools.
- Independently manage a multistate territory; prioritize accounts based on patient need and payer dynamics.
- Adhere to non-promotional guidelines; maintain patient PHI confidentiality and comply with laws/regulations/policies.
Qualifications & Skills:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCP offices; strong communication/training/relationship-building.
- Ability to navigate payer portals and CRM/field tools; strong analytical skills and reporting/data use.
- Strategic business/account plan experience; sound judgment/problem solving.
- Travel 50–70%; Microsoft Outlook/Word/Excel/PowerPoint; Salesforce CRM.
- Bachelor’s degree (health care/life sciences/business); 5+ years in sales/reimbursement/market access/specialty pharmacy/patient services/field access.
- Deep understanding of benefits investigations, PA, appeals, coverage policies; knowledge of Medicare/Medicaid/commercial plans.
- Proficiency meeting healthcare representative credentialing requirements; valid driver’s license.
Pay Range:
- $136,000 - $204,000
- Field-based Field Reimbursement Manager for Vertex Kidney Patient Support Program (KPSP), serving as local subject matter expert to nephrology practices by providing non-promotional access and reimbursement education, and supporting timely patient access through troubleshooting and payer expertise.
Responsibilities:
- Build compliant relationships with nephrology care teams and office staff involved in prior authorizations and specialty medication access.
- Partner with case management to resolve escalated access issues and ensure coordinated CRM handoffs.
- Educate offices on copay/PAP/Bridge programs and other affordability pathways.
- Follow up on case status and ensure offices meet insurance documentation requirements.
- Maintain understanding of commercial and government insurance requirements and payer trends.
- Deliver compliant on-site/virtual in-services and training on payer policies, PA/medical exception criteria, coding/billing (ICD-10, CPT), distribution/hub workflows, enrollment, and access tools.
- Independently manage a multistate territory; prioritize accounts based on patient need and payer dynamics.
- Adhere to non-promotional guidelines; maintain patient PHI confidentiality and comply with laws/regulations/policies.
Qualifications & Skills:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCP offices; strong communication/training/relationship-building.
- Ability to navigate payer portals and CRM/field tools; strong analytical skills and reporting/data use.
- Strategic business/account plan experience; sound judgment/problem solving.
- Travel 50–70%; Microsoft Outlook/Word/Excel/PowerPoint; Salesforce CRM.
- Bachelor’s degree (health care/life sciences/business); 5+ years in sales/reimbursement/market access/specialty pharmacy/patient services/field access.
- Deep understanding of benefits investigations, PA, appeals, coverage policies; knowledge of Medicare/Medicaid/commercial plans.
- Proficiency meeting healthcare representative credentialing requirements; valid driver’s license.
Pay Range:
- $136,000 - $204,000