Field Reimbursement Manager - Kidney (North Central - IA, MO, IL)
Vertex Pharmaceuticals
August 06, 2026
Remote friendly (Springfield-Branson, Missouri Area)
United States
Market Access
Responsibilities:
- Establish compliant relationships with nephrology care team/admin staff to support prior authorizations and patient access to specialty medications.
- Partner with case management to address escalated access issues; ensure coordinated handoffs using CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways to enable timely patient access.
- Follow up on case status; ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government prescription insurance coverage, access needs, and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, formulary updates, PA/medical exception criteria, ICD-10/CPT coding, distribution/hub enrollment processes, and 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 while adhering to non-promotional, compliant (legal/compliance/privacy) guidelines and protecting patient confidentiality.
Knowledge/Skills (required/preferred):
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCPs.
- Ability to navigate payer portals and CRM/salesforce tools; strong communication, training, relationship-building, and analytical skills.
- Data/reporting tools to manage caseload and prioritize; ability to travel 50–70%.
- Microsoft Office (Outlook/Word/Excel/PowerPoint) and Salesforce CRM proficiency.
- Valid driver’s license and ability to meet credentialing requirements.
Education/Experience:
- Bachelor’s degree (health care/life sciences/business); advanced degree a plus.
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles.
- Deep understanding of benefits investigations, PA processes, appeals, and payer ecosystems; knowledge of Medicare/Medicaid/commercial plans.
Pay Range:
- $136,000 - $204,000
- Establish compliant relationships with nephrology care team/admin staff to support prior authorizations and patient access to specialty medications.
- Partner with case management to address escalated access issues; ensure coordinated handoffs using CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways to enable timely patient access.
- Follow up on case status; ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government prescription insurance coverage, access needs, and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, formulary updates, PA/medical exception criteria, ICD-10/CPT coding, distribution/hub enrollment processes, and 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 while adhering to non-promotional, compliant (legal/compliance/privacy) guidelines and protecting patient confidentiality.
Knowledge/Skills (required/preferred):
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCPs.
- Ability to navigate payer portals and CRM/salesforce tools; strong communication, training, relationship-building, and analytical skills.
- Data/reporting tools to manage caseload and prioritize; ability to travel 50–70%.
- Microsoft Office (Outlook/Word/Excel/PowerPoint) and Salesforce CRM proficiency.
- Valid driver’s license and ability to meet credentialing requirements.
Education/Experience:
- Bachelor’s degree (health care/life sciences/business); advanced degree a plus.
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles.
- Deep understanding of benefits investigations, PA processes, appeals, and payer ecosystems; knowledge of Medicare/Medicaid/commercial plans.
Pay Range:
- $136,000 - $204,000