Field Reimbursement Manager - Kidney (New England - ME, VT, NH, MA, RI, CT)
Vertex Pharmaceuticals
June 27, 2026
On-site
Massachusetts, United States
Market Access
Field Reimbursement Manager (Kidney Patient Support Program - KPSP)
Key Duties And Responsibilities
- Build compliant relationships with nephrology office personnel to support patient 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 to support timely patient access.
- Follow up on case status and ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government prescription insurance requirements and payer trends.
- Conduct compliant on-site/virtual in-services and training on payer policies, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation, distribution pathways, hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Adapt engagement to office workflows; develop territory engagement plans to minimize access barriers.
- Follow strict non-promotional guidelines; maintain confidentiality of patient health information and comply with applicable laws/regulations and company policies.
Knowledge And Skills / Qualifications
- Specialty biologics/rare disease/complex pharmacy benefit experience.
- Account management experience with HCP offices to navigate access challenges.
- Ability to navigate payer portals, CRM systems, and field access tools.
- Strong communication/training/relationship-building, analytical, and data/reporting skills.
- Strategic business/account planning experience; sound judgment in decision-making.
- Travel 50–70% within assigned territory; valid driver’s license; meet health care representative credentialing requirements.
- Proficiency: Microsoft Outlook/Word/Excel/PowerPoint, Salesforce CRM.
- Bachelor’s degree (health care/life sciences/business); advanced degree a plus.
- 5+ years’ experience in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles.
- Deep understanding of benefits investigations, PA, appeals, coverage policies, and Medicare/Medicaid/commercial insurance.
Pay Range: $136,000–$204,000
Application instructions: Contact the recruiter or hiring manager for accommodations; application assistance: ApplicationAssistance@vrtx.com.
Key Duties And Responsibilities
- Build compliant relationships with nephrology office personnel to support patient 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 to support timely patient access.
- Follow up on case status and ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government prescription insurance requirements and payer trends.
- Conduct compliant on-site/virtual in-services and training on payer policies, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation, distribution pathways, hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Adapt engagement to office workflows; develop territory engagement plans to minimize access barriers.
- Follow strict non-promotional guidelines; maintain confidentiality of patient health information and comply with applicable laws/regulations and company policies.
Knowledge And Skills / Qualifications
- Specialty biologics/rare disease/complex pharmacy benefit experience.
- Account management experience with HCP offices to navigate access challenges.
- Ability to navigate payer portals, CRM systems, and field access tools.
- Strong communication/training/relationship-building, analytical, and data/reporting skills.
- Strategic business/account planning experience; sound judgment in decision-making.
- Travel 50–70% within assigned territory; valid driver’s license; meet health care representative credentialing requirements.
- Proficiency: Microsoft Outlook/Word/Excel/PowerPoint, Salesforce CRM.
- Bachelor’s degree (health care/life sciences/business); advanced degree a plus.
- 5+ years’ experience in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles.
- Deep understanding of benefits investigations, PA, appeals, coverage policies, and Medicare/Medicaid/commercial insurance.
Pay Range: $136,000–$204,000
Application instructions: Contact the recruiter or hiring manager for accommodations; application assistance: ApplicationAssistance@vrtx.com.