Field Reimbursement Manager - Kidney (Michigan-North Ohio)
Vertex Pharmaceuticals
June 27, 2026
On-site
Michigan, United States
Market Access
Key Duties and Responsibilities:
- Build compliant relationships with nephrology office personnel (care team and authorization/patient access staff) to support access to prescribed specialty medications.
- Partner with case management to address escalated access issues; use CRM triggers/workflows for coordinated handoffs.
- 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 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, distribution/hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts based on patient need and payer/KPSP demand; develop territory engagement plans.
- Adhere to strict non-promotional guidelines; protect patient confidentiality and comply with laws/regulations.
Knowledge and Skills:
- Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCP offices.
- Ability to navigate payer portals and CRM/field access tools; strong communication/training/relationship-building.
- Analytical skills; use data/reporting tools to manage caseload and prioritize.
- Travel 50–70%; proficiency with Microsoft Office and Salesforce CRM; valid driver’s license.
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-based access.
- Deep understanding of benefits investigations, PA processes, appeals, coverage policies; knowledge of Medicare/Medicaid/commercial plans.
Pay Range: $136,000–$204,000
- Build compliant relationships with nephrology office personnel (care team and authorization/patient access staff) to support access to prescribed specialty medications.
- Partner with case management to address escalated access issues; use CRM triggers/workflows for coordinated handoffs.
- 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 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, distribution/hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts based on patient need and payer/KPSP demand; develop territory engagement plans.
- Adhere to strict non-promotional guidelines; protect patient confidentiality and comply with laws/regulations.
Knowledge and Skills:
- Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCP offices.
- Ability to navigate payer portals and CRM/field access tools; strong communication/training/relationship-building.
- Analytical skills; use data/reporting tools to manage caseload and prioritize.
- Travel 50–70%; proficiency with Microsoft Office and Salesforce CRM; valid driver’s license.
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-based access.
- Deep understanding of benefits investigations, PA processes, appeals, coverage policies; knowledge of Medicare/Medicaid/commercial plans.
Pay Range: $136,000–$204,000