Field Reimbursement Manager - Kidney (North Central - IA, MO, IL)
Vertex Pharmaceuticals
August 08, 2026
Remote friendly (Illinois, United States)
United States
Market Access
Field Reimbursement Manager (Kidney Patient Support Program – KPSP)
General Summary:
Serve as local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education, supporting timely patient access through troubleshooting and payer expertise.
Key Duties And Responsibilities:
- Compliantly build relationships with nephrology care teams/administrative staff for prior authorizations and specialty medication access.
- Partner with case management to resolve escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways.
- Provide timely follow-up on case status and ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government prescription insurance access requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, PA/exception criteria, coding/billing (ICD-10, CPT), documentation, and reimbursement workflows (distribution/hub services, enrollment).
- Manage a multistate territory, prioritizing accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize access barriers; follow strict non-promotional guidelines and confidentiality laws/policies.
- Apply program business rules/work instructions for a consistent compliant patient/customer experience.
Qualifications / Skills:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCP offices to navigate access challenges.
- Proficiency with payer portals, CRM tools (Salesforce), and reporting/data tools.
- Strong communication, training, analytical, and relationship-building skills.
- Travel 50–70% within territory; valid driver’s license; credentialing to enter facilities.
Education / Experience:
- Bachelor’s degree in healthcare/life sciences/business (advanced degree preferred).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep understanding of benefits investigations, PA/appeals, coverage policies; strong Medicare/Medicaid/commercial payer knowledge.
Pay Range:
$136,000 - $204,000.
Benefits (as stated):
Annual bonus and equity; medical/dental/vision; paid time off (incl. company shutdown); educational assistance (incl. student loan repayment); commuting subsidy; 401(k) and other programs.
General Summary:
Serve as local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education, supporting timely patient access through troubleshooting and payer expertise.
Key Duties And Responsibilities:
- Compliantly build relationships with nephrology care teams/administrative staff for prior authorizations and specialty medication access.
- Partner with case management to resolve escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways.
- Provide timely follow-up on case status and ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government prescription insurance access requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, PA/exception criteria, coding/billing (ICD-10, CPT), documentation, and reimbursement workflows (distribution/hub services, enrollment).
- Manage a multistate territory, prioritizing accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize access barriers; follow strict non-promotional guidelines and confidentiality laws/policies.
- Apply program business rules/work instructions for a consistent compliant patient/customer experience.
Qualifications / Skills:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCP offices to navigate access challenges.
- Proficiency with payer portals, CRM tools (Salesforce), and reporting/data tools.
- Strong communication, training, analytical, and relationship-building skills.
- Travel 50–70% within territory; valid driver’s license; credentialing to enter facilities.
Education / Experience:
- Bachelor’s degree in healthcare/life sciences/business (advanced degree preferred).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep understanding of benefits investigations, PA/appeals, coverage policies; strong Medicare/Medicaid/commercial payer knowledge.
Pay Range:
$136,000 - $204,000.
Benefits (as stated):
Annual bonus and equity; medical/dental/vision; paid time off (incl. company shutdown); educational assistance (incl. student loan repayment); commuting subsidy; 401(k) and other programs.