Field Reimbursement Manager - Kidney (Michigan-North Ohio)
Vertex Pharmaceuticals
August 09, 2026
Remote friendly (Ohio, United States)
United States
Market Access
General Summary:
Field-based Field Reimbursement Manager (Kidney Patient Support Program, KPSP) serving as local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education, and supporting timely patient access through troubleshooting and territory-level payer expertise.
Key Duties And Responsibilities:
- Build compliant relationships with key nephrology office personnel supporting prior authorizations and specialty medication access.
- 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 to support patient access.
- Follow up on case status and ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government prescription coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training covering payer policies, formulary/coverage nuances, PA/medical exception criteria, ICD-10/CPT coding and documentation, and distribution/hub services/reimbursement workflows.
- Manage a multistate territory, prioritizing accounts based on patient need, payer dynamics, and KPSP demand; adapt to office workflows.
- Develop territory engagement plans to minimize patient-specific access barriers.
- Adhere to non-promotional compliance guidelines; maintain patient confidentiality and comply with applicable laws/regulations and company policies; apply program rules for a consistent compliant experience.
Knowledge And Skills:
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCP/office staff.
- Payer portal/CRM and field access tool navigation; strong communication, training, relationship-building, analytics, and data/reporting skills.
- Comfortable in fast-paced, results-driven environment; experience developing strategic account plans; sound judgment.
- Travel 50–70%; proficiency in Outlook/Word/Excel/PowerPoint/Salesforce CRM.
- Valid driver’s license and ability to meet credentialing requirements for facility access.
Education And Experience:
- Bachelor’s degree in healthcare, life sciences, or business (advanced degree a plus).
- 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, and payer ecosystems; knowledge of Medicare, Medicaid, and commercial insurance.
Pay Range:
- $136,000 - $204,000.
Application Instructions:
- Submit a request to the recruiter or hiring manager for accommodations as needed via ApplicationAssistance@vrtx.com.
Field-based Field Reimbursement Manager (Kidney Patient Support Program, KPSP) serving as local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education, and supporting timely patient access through troubleshooting and territory-level payer expertise.
Key Duties And Responsibilities:
- Build compliant relationships with key nephrology office personnel supporting prior authorizations and specialty medication access.
- 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 to support patient access.
- Follow up on case status and ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government prescription coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training covering payer policies, formulary/coverage nuances, PA/medical exception criteria, ICD-10/CPT coding and documentation, and distribution/hub services/reimbursement workflows.
- Manage a multistate territory, prioritizing accounts based on patient need, payer dynamics, and KPSP demand; adapt to office workflows.
- Develop territory engagement plans to minimize patient-specific access barriers.
- Adhere to non-promotional compliance guidelines; maintain patient confidentiality and comply with applicable laws/regulations and company policies; apply program rules for a consistent compliant experience.
Knowledge And Skills:
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCP/office staff.
- Payer portal/CRM and field access tool navigation; strong communication, training, relationship-building, analytics, and data/reporting skills.
- Comfortable in fast-paced, results-driven environment; experience developing strategic account plans; sound judgment.
- Travel 50–70%; proficiency in Outlook/Word/Excel/PowerPoint/Salesforce CRM.
- Valid driver’s license and ability to meet credentialing requirements for facility access.
Education And Experience:
- Bachelor’s degree in healthcare, life sciences, or business (advanced degree a plus).
- 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, and payer ecosystems; knowledge of Medicare, Medicaid, and commercial insurance.
Pay Range:
- $136,000 - $204,000.
Application Instructions:
- Submit a request to the recruiter or hiring manager for accommodations as needed via ApplicationAssistance@vrtx.com.