Field Reimbursement Manager - Kidney (Capitol - WV, VA, MD)
Vertex Pharmaceuticals
June 27, 2026
On-site
Field Pointe, MD
Market Access
Field Reimbursement Manager (Kidney Patient Support Program - KPSP)
Responsibilities
- Build compliant relationships with nephrology care teams/admin staff to support prior authorizations and patient access to specialty medications.
- Partner with case management to resolve escalated access issues and coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways; provide timely follow-up on case status and required insurance documentation.
- Maintain knowledge of commercial and government prescription insurance coverage, PA/medical exception criteria, appeals, and payer trends.
- Deliver compliant on-site/virtual in-services and training on payer policies/formulary updates, coding/billing (ICD-10, CPT), distribution/hub services, enrollment, and reimbursement workflows using approved tools/guides.
- Independently manage a multistate territory (50–70% travel), prioritize accounts by patient need/payer dynamics/KPSP demand, and tailor engagement to existing office workflows.
- Follow strict non-promotional guidelines, maintain patient confidentiality, and apply program business rules.
Qualifications
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep understanding of benefits investigations, PA processes, appeals, and coverage policies; payer knowledge for Medicare/Medicaid/commercial.
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
Skills/Tools
- Account management with HCP offices; navigate payer portals/CRM and field access tools.
- Strong communication/training, analytical/problem-solving skills, and data/reporting use.
- Proficiency: Outlook, Word, Excel, PowerPoint, Salesforce CRM; valid driver’s license; health care rep credentialing.
Pay/Benefits
- Pay range: $136,000–$204,000; eligible for annual bonus and annual equity awards.
- Total Rewards benefits may include medical/dental/vision, paid time off (including summer/winter shutdowns), education assistance, commuting subsidy, 401(k), and more.
Responsibilities
- Build compliant relationships with nephrology care teams/admin staff to support prior authorizations and patient access to specialty medications.
- Partner with case management to resolve escalated access issues and coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways; provide timely follow-up on case status and required insurance documentation.
- Maintain knowledge of commercial and government prescription insurance coverage, PA/medical exception criteria, appeals, and payer trends.
- Deliver compliant on-site/virtual in-services and training on payer policies/formulary updates, coding/billing (ICD-10, CPT), distribution/hub services, enrollment, and reimbursement workflows using approved tools/guides.
- Independently manage a multistate territory (50–70% travel), prioritize accounts by patient need/payer dynamics/KPSP demand, and tailor engagement to existing office workflows.
- Follow strict non-promotional guidelines, maintain patient confidentiality, and apply program business rules.
Qualifications
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep understanding of benefits investigations, PA processes, appeals, and coverage policies; payer knowledge for Medicare/Medicaid/commercial.
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
Skills/Tools
- Account management with HCP offices; navigate payer portals/CRM and field access tools.
- Strong communication/training, analytical/problem-solving skills, and data/reporting use.
- Proficiency: Outlook, Word, Excel, PowerPoint, Salesforce CRM; valid driver’s license; health care rep credentialing.
Pay/Benefits
- Pay range: $136,000–$204,000; eligible for annual bonus and annual equity awards.
- Total Rewards benefits may include medical/dental/vision, paid time off (including summer/winter shutdowns), education assistance, commuting subsidy, 401(k), and more.