Field Reimbursement Manager - Kidney (NJ-MD-DE)
Vertex Pharmaceuticals
June 27, 2026
On-site
New Jersey, 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; providing non-promotional access and reimbursement education and troubleshooting to support timely patient access to prescribed kidney therapies.
Key Duties And Responsibilities:
- Build compliant connections with nephrology office personnel involved in prior authorizations and patient access.
- Partner with case management to resolve escalated access issues; coordinate handoffs via CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways.
- Follow up on case status and ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government prescription coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, formulary updates, PA/medical exception criteria, ICD-10/CPT coding, documentation requirements, distribution pathways, hub services, enrollment, and reimbursement workflows.
- Manage a multistate region; prioritize accounts based on patient need, payer dynamics, and KPSP demand; develop territory engagement plans.
- Follow strict non-promotional guidelines and comply with legal/compliance/privacy guardrails; maintain confidentiality.
Knowledge And Skills:
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCP offices.
- Navigate payer portals and CRM/field tools; strong communication, training, analytical, and data/reporting skills.
- Strategic business/account planning; judgment in problem solving; travel 50–70%.
- Proficient in Microsoft Outlook/Word/Excel/PowerPoint and Salesforce CRM; valid driver’s license; meet credentialing requirements.
Education And Experience:
- Bachelor’s degree in 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 knowledge of benefits investigations, PA processes, appeals, coverage policies, and payer ecosystems; Medicare/Medicaid/commercial.
Pay/Benefits:
- $136,000–$204,000; annual bonus and annual equity awards; additional benefits include medical/dental/vision, paid time off (incl. summer/winter shutdown), educational assistance (incl. student loan repayment), commuting subsidy, matching charitable donations, and 401(k).
Application:
- Contact Talent Acquisition for accommodation requests: ApplicationAssistance@vrtx.com.
- Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP), serving as local subject matter expert to nephrology practices; providing non-promotional access and reimbursement education and troubleshooting to support timely patient access to prescribed kidney therapies.
Key Duties And Responsibilities:
- Build compliant connections with nephrology office personnel involved in prior authorizations and patient access.
- Partner with case management to resolve escalated access issues; coordinate handoffs via CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways.
- Follow up on case status and ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government prescription coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, formulary updates, PA/medical exception criteria, ICD-10/CPT coding, documentation requirements, distribution pathways, hub services, enrollment, and reimbursement workflows.
- Manage a multistate region; prioritize accounts based on patient need, payer dynamics, and KPSP demand; develop territory engagement plans.
- Follow strict non-promotional guidelines and comply with legal/compliance/privacy guardrails; maintain confidentiality.
Knowledge And Skills:
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCP offices.
- Navigate payer portals and CRM/field tools; strong communication, training, analytical, and data/reporting skills.
- Strategic business/account planning; judgment in problem solving; travel 50–70%.
- Proficient in Microsoft Outlook/Word/Excel/PowerPoint and Salesforce CRM; valid driver’s license; meet credentialing requirements.
Education And Experience:
- Bachelor’s degree in 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 knowledge of benefits investigations, PA processes, appeals, coverage policies, and payer ecosystems; Medicare/Medicaid/commercial.
Pay/Benefits:
- $136,000–$204,000; annual bonus and annual equity awards; additional benefits include medical/dental/vision, paid time off (incl. summer/winter shutdown), educational assistance (incl. student loan repayment), commuting subsidy, matching charitable donations, and 401(k).
Application:
- Contact Talent Acquisition for accommodation requests: ApplicationAssistance@vrtx.com.