Field Reimbursement Manager - Kidney (North Central - IA, MO, IL)
Vertex Pharmaceuticals
August 09, 2026
Remote friendly (United States)
United States
Market Access
General Summary:
Field Reimbursement Manager (Kidney Patient Support Program, KPSP) — field-based subject matter expert to nephrology practices, providing non-promotional access and reimbursement education; troubleshoot and use territory-level payer expertise to support timely patient access to prescribed Vertex kidney therapies.
Key Duties and Responsibilities:
- Compliantly build connections with nephrology care teams and prior authorization/patient access staff.
- Partner with case management to address escalated access issues; coordinate handoffs using 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 insurance coverage for access and payer trends.
- Deliver compliant on-site/virtual in-services and trainings on payer policies, formulary updates, coverage nuances, PA/medical exception criteria, ICD-10/CPT and documentation, and distribution/hub/reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize access barriers; adhere to strict non-promotional and privacy/compliance requirements; maintain patient confidentiality.
Knowledge, Skills, and Qualifications:
- Experience with specialty biologics/rare disease therapies/complex PBM products.
- Account management with HCP offices; ability to navigate payer portals and CRM/tools.
- Strong communication, training, relationship-building, analytical, and reporting skills.
- Experience developing/executing strategic business/account plans; sound judgment.
- Travel 50–70% in assigned territory.
- Proficient with Outlook/Word/Excel/PowerPoint/Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education and Experience:
- Bachelor’s degree (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 processes, appeals, coverage policies, and payer ecosystems; Medicare/Medicaid/commercial.
Pay Range:
$136,000–$204,000; eligible for annual bonus and annual equity.
Field Reimbursement Manager (Kidney Patient Support Program, KPSP) — field-based subject matter expert to nephrology practices, providing non-promotional access and reimbursement education; troubleshoot and use territory-level payer expertise to support timely patient access to prescribed Vertex kidney therapies.
Key Duties and Responsibilities:
- Compliantly build connections with nephrology care teams and prior authorization/patient access staff.
- Partner with case management to address escalated access issues; coordinate handoffs using 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 insurance coverage for access and payer trends.
- Deliver compliant on-site/virtual in-services and trainings on payer policies, formulary updates, coverage nuances, PA/medical exception criteria, ICD-10/CPT and documentation, and distribution/hub/reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize access barriers; adhere to strict non-promotional and privacy/compliance requirements; maintain patient confidentiality.
Knowledge, Skills, and Qualifications:
- Experience with specialty biologics/rare disease therapies/complex PBM products.
- Account management with HCP offices; ability to navigate payer portals and CRM/tools.
- Strong communication, training, relationship-building, analytical, and reporting skills.
- Experience developing/executing strategic business/account plans; sound judgment.
- Travel 50–70% in assigned territory.
- Proficient with Outlook/Word/Excel/PowerPoint/Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education and Experience:
- Bachelor’s degree (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 processes, appeals, coverage policies, and payer ecosystems; Medicare/Medicaid/commercial.
Pay Range:
$136,000–$204,000; eligible for annual bonus and annual equity.