Field Reimbursement Manager - Kidney (Michigan-North Ohio)
Vertex Pharmaceuticals
June 27, 2026
On-site
Ohio, United States
Market Access
General Summary:
Field-based role as local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education; supports timely patient access to prescribed Vertex kidney therapies through troubleshooting and payer expertise.
Key Duties and Responsibilities:
- Build compliant relationships with nephrology office personnel involved in prior authorizations and patient access.
- Partner with case management to resolve escalated access issues; ensure coordinated CRM/workflow handoffs.
- 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 prescription coverage requirements and payer trends.
- Conduct compliant on-site/virtual in-services and training on payer policies/formulary updates, PA/medical exceptions, coding/billing (ICD-10, CPT), documentation, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize access barriers; adhere to strict non-promotional and confidentiality requirements.
Knowledge, Skills, Qualifications:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management experience with HCP offices; ability to navigate payer portals, CRM systems, and field tools.
- Strong communication, training, relationship-building, analytical, and data/reporting skills.
- Strategic business/account planning; sound judgment.
- Travel 50–70%; Microsoft Office and Salesforce CRM.
- Valid driver’s license and ability to meet facility credentialing requirements.
Education/Experience:
- Bachelor’s degree (health care/life sciences/business); advanced degree preferred.
- 5+ years in sales/reimbursement/market access/specialty pharmacy/patient services/field access roles.
- Deep understanding of benefits investigations, PA processes, appeals, coverage policies; Medicare/Medicaid/commercial knowledge.
Pay Range:
$136,000 - $204,000
Field-based role as local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education; supports timely patient access to prescribed Vertex kidney therapies through troubleshooting and payer expertise.
Key Duties and Responsibilities:
- Build compliant relationships with nephrology office personnel involved in prior authorizations and patient access.
- Partner with case management to resolve escalated access issues; ensure coordinated CRM/workflow handoffs.
- 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 prescription coverage requirements and payer trends.
- Conduct compliant on-site/virtual in-services and training on payer policies/formulary updates, PA/medical exceptions, coding/billing (ICD-10, CPT), documentation, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize access barriers; adhere to strict non-promotional and confidentiality requirements.
Knowledge, Skills, Qualifications:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management experience with HCP offices; ability to navigate payer portals, CRM systems, and field tools.
- Strong communication, training, relationship-building, analytical, and data/reporting skills.
- Strategic business/account planning; sound judgment.
- Travel 50–70%; Microsoft Office and Salesforce CRM.
- Valid driver’s license and ability to meet facility credentialing requirements.
Education/Experience:
- Bachelor’s degree (health care/life sciences/business); advanced degree preferred.
- 5+ years in sales/reimbursement/market access/specialty pharmacy/patient services/field access roles.
- Deep understanding of benefits investigations, PA processes, appeals, coverage policies; Medicare/Medicaid/commercial knowledge.
Pay Range:
$136,000 - $204,000