Field Reimbursement Manager - Kidney (Michigan-North Ohio)
Vertex Pharmaceuticals
August 30, 2026
Remote friendly (Michigan, United States)
United States
Market Access
General Summary:
Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP), serving as local subject matter expert to nephrology practices. Provide non-promotional access and reimbursement education and support timely patient access through troubleshooting and payer expertise.
Responsibilities:
- Build compliant relationships with nephrology office personnel (care team and authorization/access staff).
- Partner with case management on escalated access issues; use CRM triggers/workflows for coordinated handoffs.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways.
- Follow up on case status; ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government prescription coverage and payer trends.
- Conduct compliant on-site/virtual in-services and training on payer policies, formulary/coverage nuances, PA/exception criteria, ICD-10/CPT coding, 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 patient-specific access barriers.
- Adhere to non-promotional and privacy/compliance requirements; maintain confidentiality of patient health information.
Qualifications & Skills:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCPs/office staff; navigate payer portals and CRM/salesforce tools.
- Strong communication/training/relationship-building; analytical and data/reporting skills.
- Ability to travel 50–70% and work in a fast-paced, results-driven environment.
- Proficiency in Microsoft Outlook/Word/Excel/PowerPoint and Salesforce CRM.
- Valid driver’s license; meet healthcare credentialing requirements.
- Bachelor’s degree (healthcare/life sciences/business); 5+ years in reimbursement/market access/specialty pharmacy/patient services/field access.
- Deep understanding of benefits investigations, PA/appeals/coverage, and payer ecosystems; Medicare/Medicaid/commercial knowledge.
Pay Range:
- $136,000 - $204,000
Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP), serving as local subject matter expert to nephrology practices. Provide non-promotional access and reimbursement education and support timely patient access through troubleshooting and payer expertise.
Responsibilities:
- Build compliant relationships with nephrology office personnel (care team and authorization/access staff).
- Partner with case management on escalated access issues; use CRM triggers/workflows for coordinated handoffs.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways.
- Follow up on case status; ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government prescription coverage and payer trends.
- Conduct compliant on-site/virtual in-services and training on payer policies, formulary/coverage nuances, PA/exception criteria, ICD-10/CPT coding, 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 patient-specific access barriers.
- Adhere to non-promotional and privacy/compliance requirements; maintain confidentiality of patient health information.
Qualifications & Skills:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCPs/office staff; navigate payer portals and CRM/salesforce tools.
- Strong communication/training/relationship-building; analytical and data/reporting skills.
- Ability to travel 50–70% and work in a fast-paced, results-driven environment.
- Proficiency in Microsoft Outlook/Word/Excel/PowerPoint and Salesforce CRM.
- Valid driver’s license; meet healthcare credentialing requirements.
- Bachelor’s degree (healthcare/life sciences/business); 5+ years in reimbursement/market access/specialty pharmacy/patient services/field access.
- Deep understanding of benefits investigations, PA/appeals/coverage, and payer ecosystems; Medicare/Medicaid/commercial knowledge.
Pay Range:
- $136,000 - $204,000