Field Reimbursement Manager - Kidney (North Central - IA, MO, IL)
Vertex Pharmaceuticals
August 09, 2026
Remote friendly (Iowa, United States)
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 by providing non-promotional access and reimbursement education; troubleshoot to support timely patient access to prescribed Vertex kidney therapies.
Key Duties and Responsibilities:
- Build compliant relationships with nephrology office care and administrative staff for prior authorizations and patient access to specialty medications.
- Partner with case management to resolve escalated access issues; coordinate handoffs via CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways; provide case status follow-up and clarify insurance documentation requirements.
- Maintain understanding of commercial and government insurance coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies/formulary updates, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation, distribution/hub enrollment and reimbursement workflows.
- Manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize patient-specific access barriers; follow strict non-promotional guidelines, confidentiality, and applicable compliance/privacy guardrails.
Knowledge and Skills / Qualifications:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products; account management with HCPs and office staff.
- Ability to navigate payer portals and CRM tools; strong communication/training/relationship skills; analytical/data-driven prioritization.
- Strategic business/account planning; good judgment in problem solving.
- Travel 50–70%; proficiency with Microsoft Office and Salesforce CRM.
- Valid driver’s license; meet healthcare credentialing requirements.
- Bachelor’s degree (health care/life sciences/business); 5+ years in sales/reimbursement/market access/specialty pharmacy/patient services/field access roles.
- Deep knowledge of benefits investigations, PA, appeals, coverage policies; payer knowledge of Medicare, Medicaid, and commercial plans.
- Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP), serving as local subject matter expert to nephrology practices by providing non-promotional access and reimbursement education; troubleshoot to support timely patient access to prescribed Vertex kidney therapies.
Key Duties and Responsibilities:
- Build compliant relationships with nephrology office care and administrative staff for prior authorizations and patient access to specialty medications.
- Partner with case management to resolve escalated access issues; coordinate handoffs via CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways; provide case status follow-up and clarify insurance documentation requirements.
- Maintain understanding of commercial and government insurance coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies/formulary updates, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation, distribution/hub enrollment and reimbursement workflows.
- Manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize patient-specific access barriers; follow strict non-promotional guidelines, confidentiality, and applicable compliance/privacy guardrails.
Knowledge and Skills / Qualifications:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products; account management with HCPs and office staff.
- Ability to navigate payer portals and CRM tools; strong communication/training/relationship skills; analytical/data-driven prioritization.
- Strategic business/account planning; good judgment in problem solving.
- Travel 50–70%; proficiency with Microsoft Office and Salesforce CRM.
- Valid driver’s license; meet healthcare credentialing requirements.
- Bachelor’s degree (health care/life sciences/business); 5+ years in sales/reimbursement/market access/specialty pharmacy/patient services/field access roles.
- Deep knowledge of benefits investigations, PA, appeals, coverage policies; payer knowledge of Medicare, Medicaid, and commercial plans.