Field Reimbursement Manager - Kidney (Great Plains - NV, UT, CO, NE, KS)
Vertex Pharmaceuticals
June 27, 2026
On-site
Utah, United States
Market Access
Field Reimbursement Manager (Kidney Patient Support Program - KPSP)
General Summary
- Field-based role serving as local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education, troubleshooting to support timely patient access to prescribed Vertex kidney therapies.
Key Duties And Responsibilities
- Build compliant connections with nephrology office personnel (care team and staff handling prior authorizations/access).
- Coordinate with case management to resolve escalated access issues using CRM workflows.
- Educate offices on copay assistance, PAP, Bridge programs, and affordability pathways.
- Follow up on case status; ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial/government coverage requirements and payer trends.
- Deliver compliant in-services/training (on-site/virtual) on payer policies/formularies; PA/medical exception criteria; ICD-10/CPT/coding and documentation; distribution/hub services/enrollment and reimbursement workflows.
- Manage a multistate territory; develop engagement plans to minimize patient access barriers.
- Follow non-promotional, legal/compliance/privacy guardrails; maintain patient confidentiality.
Knowledge And Skills
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCP offices.
- Ability to navigate payer portals/CRM; strong communication and training skills.
- Analytical skills; use data/reporting tools for caseload prioritization.
- Travel 50–70%; Microsoft Office; Salesforce CRM; valid driver’s license; industry credentialing.
Education And Experience
- Bachelor’s degree (health care/life sciences/business) (advanced degree preferred).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field access.
- Deep understanding of benefits investigations, PA/appeals, coverage policies; Medicare/Medicaid/commercial payer knowledge.
Compensation
- $136,000–$204,000 base; eligible for annual bonus and annual equity awards; some roles may be eligible for overtime.
General Summary
- Field-based role serving as local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education, troubleshooting to support timely patient access to prescribed Vertex kidney therapies.
Key Duties And Responsibilities
- Build compliant connections with nephrology office personnel (care team and staff handling prior authorizations/access).
- Coordinate with case management to resolve escalated access issues using CRM workflows.
- Educate offices on copay assistance, PAP, Bridge programs, and affordability pathways.
- Follow up on case status; ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial/government coverage requirements and payer trends.
- Deliver compliant in-services/training (on-site/virtual) on payer policies/formularies; PA/medical exception criteria; ICD-10/CPT/coding and documentation; distribution/hub services/enrollment and reimbursement workflows.
- Manage a multistate territory; develop engagement plans to minimize patient access barriers.
- Follow non-promotional, legal/compliance/privacy guardrails; maintain patient confidentiality.
Knowledge And Skills
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCP offices.
- Ability to navigate payer portals/CRM; strong communication and training skills.
- Analytical skills; use data/reporting tools for caseload prioritization.
- Travel 50–70%; Microsoft Office; Salesforce CRM; valid driver’s license; industry credentialing.
Education And Experience
- Bachelor’s degree (health care/life sciences/business) (advanced degree preferred).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field access.
- Deep understanding of benefits investigations, PA/appeals, coverage policies; Medicare/Medicaid/commercial payer knowledge.
Compensation
- $136,000–$204,000 base; eligible for annual bonus and annual equity awards; some roles may be eligible for overtime.