Field Reimbursement Manager - Kidney (Central Southwest - AZ, NM, TX, OK)
Vertex Pharmaceuticals
June 27, 2026
On-site
United States
Market Access
General Summary:
Field-based Field Reimbursement Manager (Kidney Patient Support Program, KPSP) serving as a subject matter expert to nephrology practices to provide non-promotional access/reimbursement education and troubleshoot for timely patient access.
Key Duties and Responsibilities:
- Build compliant relationships with nephrology office staff (care team and prior-authorization/access personnel).
- Partner with case management to resolve escalated access issues; coordinate handoffs via CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways.
- Follow up on case status and ensure understanding of insurance documentation requirements.
- Maintain knowledge of commercial and government insurance coverage requirements and payer trends.
- Conduct compliant on-site/virtual in-services and training on payer policies/formulary updates, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation, and distribution/hub and reimbursement workflows.
- Manage a multistate territory; adapt engagement to office workflows; develop territory engagement plans to reduce access barriers.
- Follow non-promotional, confidentiality, and applicable legal/compliance/privacy requirements; apply program business rules/work instructions.
Knowledge/Skills & Qualifications:
- Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCP offices.
- Payer portal/CRM tool navigation; strong communication/training/relationship skills.
- Analytical/data reporting skills; judgment and problem-solving.
- Travel 50–70% within territory; Microsoft Office and Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education/Experience:
- Bachelor’s degree (healthcare/life sciences/business); advanced degree preferred.
- 5+ years in sales, reimbursement, market access, specialty pharmacy/patient services, or field-based access roles.
- Deep understanding of benefits investigations, PA processes/appeals, and payer ecosystems; knowledge of Medicare/Medicaid/commercial plans.
Pay Range:
$136,000–$204,000. Eligible for annual bonus and annual equity awards.
Field-based Field Reimbursement Manager (Kidney Patient Support Program, KPSP) serving as a subject matter expert to nephrology practices to provide non-promotional access/reimbursement education and troubleshoot for timely patient access.
Key Duties and Responsibilities:
- Build compliant relationships with nephrology office staff (care team and prior-authorization/access personnel).
- Partner with case management to resolve escalated access issues; coordinate handoffs via CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways.
- Follow up on case status and ensure understanding of insurance documentation requirements.
- Maintain knowledge of commercial and government insurance coverage requirements and payer trends.
- Conduct compliant on-site/virtual in-services and training on payer policies/formulary updates, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation, and distribution/hub and reimbursement workflows.
- Manage a multistate territory; adapt engagement to office workflows; develop territory engagement plans to reduce access barriers.
- Follow non-promotional, confidentiality, and applicable legal/compliance/privacy requirements; apply program business rules/work instructions.
Knowledge/Skills & Qualifications:
- Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCP offices.
- Payer portal/CRM tool navigation; strong communication/training/relationship skills.
- Analytical/data reporting skills; judgment and problem-solving.
- Travel 50–70% within territory; Microsoft Office and Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education/Experience:
- Bachelor’s degree (healthcare/life sciences/business); advanced degree preferred.
- 5+ years in sales, reimbursement, market access, specialty pharmacy/patient services, or field-based access roles.
- Deep understanding of benefits investigations, PA processes/appeals, and payer ecosystems; knowledge of Medicare/Medicaid/commercial plans.
Pay Range:
$136,000–$204,000. Eligible for annual bonus and annual equity awards.