Field Reimbursement Manager - Kidney (Chicago, IL)
Vertex Pharmaceuticals
August 07, 2026
Remote friendly (United States)
United States
Market Access
Field Reimbursement Manager (Kidney Patient Support Program - KPSP)
Responsibilities:
- Establish compliant relationships with nephrology office care team and administrative staff supporting prior authorizations and patient access to specialty medications.
- Partner with case management to address escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways to support timely patient access.
- Follow up on case status; ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial/government prescription coverage requirements, PA trends, and payer ecosystems.
- Conduct compliant on-site and virtual in-services/training on payer policies/formulary updates, PA/medical exceptions, coding/billing (ICD-10, CPT), documentation, distribution pathways/hub services/enrollment, and reimbursement workflows.
- Manage a multistate territory, prioritize accounts by patient need and payer dynamics, and develop territory engagement plans.
- Adhere to non-promotional guidelines, comply with legal/compliance/privacy guardrails, maintain patient confidentiality, and follow program work instructions.
Qualifications & Skills:
- Experience with specialty biologics/rare disease or complex pharmacy benefit products; account management with HCPs/office staff.
- Ability to navigate payer portals, CRM systems, and field access tools.
- Strong training/relationship-building, analytical skills, and data/reporting use to manage caseload.
- Strategic business/account plan experience; sound judgment in problem-solving.
- Travel 50–70% within territory; valid driver’s license; meet healthcare representative credentialing.
- Proficient: Microsoft Outlook/Word/Excel/PowerPoint; Salesforce CRM.
Education & Experience:
- Bachelor’s degree in health care/life sciences/business (advanced degree preferred).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep understanding of benefits investigations, PA, appeals, coverage policies, and Medicare/Medicaid/commercial plans.
Pay:
- $136,000–$204,000; eligible for annual bonus and annual equity awards; overtime may apply.
Responsibilities:
- Establish compliant relationships with nephrology office care team and administrative staff supporting prior authorizations and patient access to specialty medications.
- Partner with case management to address escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways to support timely patient access.
- Follow up on case status; ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial/government prescription coverage requirements, PA trends, and payer ecosystems.
- Conduct compliant on-site and virtual in-services/training on payer policies/formulary updates, PA/medical exceptions, coding/billing (ICD-10, CPT), documentation, distribution pathways/hub services/enrollment, and reimbursement workflows.
- Manage a multistate territory, prioritize accounts by patient need and payer dynamics, and develop territory engagement plans.
- Adhere to non-promotional guidelines, comply with legal/compliance/privacy guardrails, maintain patient confidentiality, and follow program work instructions.
Qualifications & Skills:
- Experience with specialty biologics/rare disease or complex pharmacy benefit products; account management with HCPs/office staff.
- Ability to navigate payer portals, CRM systems, and field access tools.
- Strong training/relationship-building, analytical skills, and data/reporting use to manage caseload.
- Strategic business/account plan experience; sound judgment in problem-solving.
- Travel 50–70% within territory; valid driver’s license; meet healthcare representative credentialing.
- Proficient: Microsoft Outlook/Word/Excel/PowerPoint; Salesforce CRM.
Education & Experience:
- Bachelor’s degree in health care/life sciences/business (advanced degree preferred).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep understanding of benefits investigations, PA, appeals, coverage policies, and Medicare/Medicaid/commercial plans.
Pay:
- $136,000–$204,000; eligible for annual bonus and annual equity awards; overtime may apply.