Field Reimbursement Manager - Kidney (North Central - IA, MO, IL)
Vertex Pharmaceuticals
June 27, 2026
On-site
Illinois, United States
Market Access
Key Duties and Responsibilities
- Compliantly establish strong connections with nephrology office personnel (care team and administrative staff) responsible for prior authorizations and patient access to specialty medications.
- Partner with case management to address escalated access issues; ensure coordinated handoffs using CRM triggers and workflows.
- Support timely patient access by educating offices on copay, PAP, Bridge programs, and other affordability pathways.
- Provide timely follow-up on case status; ensure offices understand insurance documentation requirements.
- Maintain understanding of commercial and government prescription insurance coverage requirements for access and payer trends.
- Conduct on-site and virtual in-services/training on regional payer policies, formulary updates, coverage nuances; PA/medical exception criteria; coding/billing (ICD-10, CPT) and documentation; distribution pathways, hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate geographic region; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Adapt engagement to office workflows; avoid introducing complexities.
- Develop territory engagement plans to minimize patient-specific access barriers.
- Adhere to strict non-promotional guidelines; maintain confidentiality and comply with applicable laws/regulations and company policies.
Knowledge and Skills/Qualifications
- Experience with specialty biologics/rare disease therapies or complex pharmacy benefit products.
- Account management experience with HCPs and office staff 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; ability to prioritize caseload.
- Experience developing/executing strategic account plans; sound judgment.
- Travel 50–70% within territory.
- Proficiency: Microsoft Outlook/Word/Excel/PowerPoint, Salesforce CRM.
- Valid driver’s license; meet credentialing requirements.
Education and Experience
- Bachelor’s degree in health care, life sciences, or business (advanced degree a plus).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep understanding of benefits investigations, PA processes, appeals, coverage policies, and payer ecosystems.
- Payer knowledge of Medicare, Medicaid, and commercial insurance.
Pay Range
- $136,000 - $204,000
Role is eligible for annual bonus and annual equity awards.
- Compliantly establish strong connections with nephrology office personnel (care team and administrative staff) responsible for prior authorizations and patient access to specialty medications.
- Partner with case management to address escalated access issues; ensure coordinated handoffs using CRM triggers and workflows.
- Support timely patient access by educating offices on copay, PAP, Bridge programs, and other affordability pathways.
- Provide timely follow-up on case status; ensure offices understand insurance documentation requirements.
- Maintain understanding of commercial and government prescription insurance coverage requirements for access and payer trends.
- Conduct on-site and virtual in-services/training on regional payer policies, formulary updates, coverage nuances; PA/medical exception criteria; coding/billing (ICD-10, CPT) and documentation; distribution pathways, hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate geographic region; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Adapt engagement to office workflows; avoid introducing complexities.
- Develop territory engagement plans to minimize patient-specific access barriers.
- Adhere to strict non-promotional guidelines; maintain confidentiality and comply with applicable laws/regulations and company policies.
Knowledge and Skills/Qualifications
- Experience with specialty biologics/rare disease therapies or complex pharmacy benefit products.
- Account management experience with HCPs and office staff 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; ability to prioritize caseload.
- Experience developing/executing strategic account plans; sound judgment.
- Travel 50–70% within territory.
- Proficiency: Microsoft Outlook/Word/Excel/PowerPoint, Salesforce CRM.
- Valid driver’s license; meet credentialing requirements.
Education and Experience
- Bachelor’s degree in health care, life sciences, or business (advanced degree a plus).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep understanding of benefits investigations, PA processes, appeals, coverage policies, and payer ecosystems.
- Payer knowledge of Medicare, Medicaid, and commercial insurance.
Pay Range
- $136,000 - $204,000
Role is eligible for annual bonus and annual equity awards.