Field Reimbursement Manager - Kidney (NJ-MD-DE)
Vertex Pharmaceuticals
June 25, 2026
On-site
Pennsylvania, United States
Market Access
Key Duties And Responsibilities
- Compliantly establish connections with nephrology office personnel to support patient access to specialty medications.
- Partner with case management to address escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways to support timely access.
- Provide timely follow-up on case status and ensure offices understand insurance documentation requirements.
- Maintain understanding of commercial and government prescription coverage requirements, payer trends.
- Conduct compliant on-site and virtual in-services and training on payer policies/formulary updates; PA/medical exception criteria, ICD-10/CPT, documentation; distribution pathways, hub services, enrollment, reimbursement workflows.
- Independently manage a multistate region, prioritizing accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize patient-specific access barriers.
- Adhere to strict non-promotional guidelines; maintain confidentiality of patient health information and comply with applicable laws/regulations.
Knowledge And Skills
- Experience with specialty biologics/rare disease or complex pharmacy benefit products.
- Account management with HCPs/office staff; navigate payer portals, CRM and field tools.
- Strong communication/training/relationship-building; analytical and data/reporting skills.
- Ability to develop and execute account/business plans; sound judgment; travel 50–70%.
- Proficiency: Microsoft Outlook/Word/Excel/PowerPoint, Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education And Experience
- Bachelor’s degree in health care, life sciences, or business; advanced degree is 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, and commercial insurance.
Benefits
- Eligible for annual bonus and annual equity awards.
Pay Range
- $136,000 - $204,000.
- Compliantly establish connections with nephrology office personnel to support patient access to specialty medications.
- Partner with case management to address escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways to support timely access.
- Provide timely follow-up on case status and ensure offices understand insurance documentation requirements.
- Maintain understanding of commercial and government prescription coverage requirements, payer trends.
- Conduct compliant on-site and virtual in-services and training on payer policies/formulary updates; PA/medical exception criteria, ICD-10/CPT, documentation; distribution pathways, hub services, enrollment, reimbursement workflows.
- Independently manage a multistate region, prioritizing accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize patient-specific access barriers.
- Adhere to strict non-promotional guidelines; maintain confidentiality of patient health information and comply with applicable laws/regulations.
Knowledge And Skills
- Experience with specialty biologics/rare disease or complex pharmacy benefit products.
- Account management with HCPs/office staff; navigate payer portals, CRM and field tools.
- Strong communication/training/relationship-building; analytical and data/reporting skills.
- Ability to develop and execute account/business plans; sound judgment; travel 50–70%.
- Proficiency: Microsoft Outlook/Word/Excel/PowerPoint, Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education And Experience
- Bachelor’s degree in health care, life sciences, or business; advanced degree is 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, and commercial insurance.
Benefits
- Eligible for annual bonus and annual equity awards.
Pay Range
- $136,000 - $204,000.