Field Reimbursement Manager - Kidney (New England - ME, VT, NH, MA, RI, CT)
Vertex Pharmaceuticals
June 27, 2026
On-site
Greater Hartford
Market Access
Key Duties and Responsibilities
- Compliantly establish strong connections with nephrology office personnel to support patient access to prescribed specialty medications.
- Partner with case management to address escalated access issues; ensure coordinated handoffs using CRM triggers and workflows.
- Support timely patient access by educating offices on copay, PAP, Bridge programs, and other affordability pathways.
- Provide timely follow-up on case status; ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government prescription insurance coverage requirements for access and payer trends.
- Conduct on-site and virtual in-services and training using approved payer guides, checklists, access tools, and workflow maps covering: payer policies/formulary updates; PA/medical exception criteria; coding/billing (ICD-10, CPT) and documentation; distribution pathways, hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate geographic region; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize patient-specific access barriers.
- Follow strict non-promotional guidelines and comply with legal/compliance/privacy guardrails.
- Maintain confidentiality of patient health information and comply with applicable laws and company policies.
Knowledge and Skills / Qualifications
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products; account management with HCPs and office staff.
- Ability to navigate payer portals, CRM systems, and field access tools.
- Strong communication/training/relationship-building and analytical skills; data/reporting ability.
- Ability to work in a fast-paced, results-driven environment; experience with strategic business/account plans.
- Judgment in decision-making and problem solving.
- Travel 50–70% within assigned territory.
- Proficiency: Microsoft Outlook/Word/Excel/PowerPoint, Salesforce CRM.
- Valid driver’s license; ability to meet safe driving requirements and healthcare representative credentialing.
Education and Experience
- Bachelor’s degree in healthcare/life sciences/business (advanced degree a plus).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles.
- Deep understanding of benefits investigations, PA processes, appeals, coverage policies, and payer ecosystems; knowledge of Medicare/Medicaid/commercial insurance.
Pay Range
- $136,000 - $204,000 (annual bonus and annual equity awards).
- Compliantly establish strong connections with nephrology office personnel to support patient access to prescribed specialty medications.
- Partner with case management to address escalated access issues; ensure coordinated handoffs using CRM triggers and workflows.
- Support timely patient access by educating offices on copay, PAP, Bridge programs, and other affordability pathways.
- Provide timely follow-up on case status; ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government prescription insurance coverage requirements for access and payer trends.
- Conduct on-site and virtual in-services and training using approved payer guides, checklists, access tools, and workflow maps covering: payer policies/formulary updates; PA/medical exception criteria; coding/billing (ICD-10, CPT) and documentation; distribution pathways, hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate geographic region; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize patient-specific access barriers.
- Follow strict non-promotional guidelines and comply with legal/compliance/privacy guardrails.
- Maintain confidentiality of patient health information and comply with applicable laws and company policies.
Knowledge and Skills / Qualifications
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products; account management with HCPs and office staff.
- Ability to navigate payer portals, CRM systems, and field access tools.
- Strong communication/training/relationship-building and analytical skills; data/reporting ability.
- Ability to work in a fast-paced, results-driven environment; experience with strategic business/account plans.
- Judgment in decision-making and problem solving.
- Travel 50–70% within assigned territory.
- Proficiency: Microsoft Outlook/Word/Excel/PowerPoint, Salesforce CRM.
- Valid driver’s license; ability to meet safe driving requirements and healthcare representative credentialing.
Education and Experience
- Bachelor’s degree in healthcare/life sciences/business (advanced degree a plus).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles.
- Deep understanding of benefits investigations, PA processes, appeals, coverage policies, and payer ecosystems; knowledge of Medicare/Medicaid/commercial insurance.
Pay Range
- $136,000 - $204,000 (annual bonus and annual equity awards).