Field Reimbursement Manager - Kidney (NJ-MD-DE)
Vertex Pharmaceuticals
June 27, 2026
On-site
United States
Market Access
Key Duties And Responsibilities:
- Build compliant relationships with nephrology offices (care team/admins) to support prior authorizations and patient access to specialty medications.
- Partner with case management to resolve escalated access issues; coordinate handoffs via CRM triggers/workflows.
- Educate offices on copay assistance, PAP, Bridge programs, and affordability pathways to enable timely patient access.
- Provide follow-up on case status and ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government prescription insurance coverage requirements and payer trends.
- Deliver compliant on-site/virtual in-services and training on payer policies/formulary updates, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation, and distribution/hub/reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts based on patient need/payer dynamics/KPSP demand.
- Develop territory engagement plans to minimize patient access barriers; adhere to strict non-promotional guidelines and confidentiality laws.
Knowledge And Skills:
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCP offices.
- Navigate payer portals, CRM systems, and field access tools; strong communication/training/relationship skills.
- Analytical skills; ability to use data/reporting to manage caseload/prioritize patients.
- Strategic account plan experience; sound judgment; travel 50–70%.
- Proficient with Microsoft Outlook/Word/Excel/PowerPoint and Salesforce CRM.
- Valid driver’s license; ability to meet healthcare credentialing requirements.
Education And Experience:
- Bachelor’s degree (health care/life sciences/business); advanced degree preferred.
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles.
- Deep understanding of benefits investigations, PA/appeals, coverage policies; payer knowledge (Medicare, Medicaid, commercial).
Pay/Benefits:
- $136,000–$204,000 base; eligible for annual bonus and annual equity awards; comprehensive benefits incl. medical/dental/vision, paid time off, education assistance/student loan repayment, commuting subsidy, matching charitable donations, 401(k).
- Build compliant relationships with nephrology offices (care team/admins) to support prior authorizations and patient access to specialty medications.
- Partner with case management to resolve escalated access issues; coordinate handoffs via CRM triggers/workflows.
- Educate offices on copay assistance, PAP, Bridge programs, and affordability pathways to enable timely patient access.
- Provide follow-up on case status and ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government prescription insurance coverage requirements and payer trends.
- Deliver compliant on-site/virtual in-services and training on payer policies/formulary updates, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation, and distribution/hub/reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts based on patient need/payer dynamics/KPSP demand.
- Develop territory engagement plans to minimize patient access barriers; adhere to strict non-promotional guidelines and confidentiality laws.
Knowledge And Skills:
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCP offices.
- Navigate payer portals, CRM systems, and field access tools; strong communication/training/relationship skills.
- Analytical skills; ability to use data/reporting to manage caseload/prioritize patients.
- Strategic account plan experience; sound judgment; travel 50–70%.
- Proficient with Microsoft Outlook/Word/Excel/PowerPoint and Salesforce CRM.
- Valid driver’s license; ability to meet healthcare credentialing requirements.
Education And Experience:
- Bachelor’s degree (health care/life sciences/business); advanced degree preferred.
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles.
- Deep understanding of benefits investigations, PA/appeals, coverage policies; payer knowledge (Medicare, Medicaid, commercial).
Pay/Benefits:
- $136,000–$204,000 base; eligible for annual bonus and annual equity awards; comprehensive benefits incl. medical/dental/vision, paid time off, education assistance/student loan repayment, commuting subsidy, matching charitable donations, 401(k).