Field Reimbursement Manager - Kidney (Northern California - San Francisco, San Jose, Sacramento)
Vertex Pharmaceuticals
June 27, 2026
On-site
Nevada, 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 to provide non-promotional access/reimbursement education and troubleshoot to support timely patient access to prescribed kidney therapies.
Key Duties and Responsibilities:
- Build compliant relationships with nephrology care teams and administrative staff (prior authorizations/patient access).
- Partner with case management to resolve escalated access issues and coordinate handoffs via CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways.
- Follow up on case status and ensure offices meet insurance documentation requirements.
- Maintain understanding of commercial/government coverage requirements and payer trends.
- Deliver compliant on-site/virtual in-services and training on payer policies, formulary updates, PA/exception criteria, coding/billing (ICD-10, CPT), documentation, and reimbursement workflows (hub services, enrollment, distribution).
- Manage a multistate region, prioritize accounts by patient need/payer dynamics/KPSP demand, and develop territory engagement plans.
- Adhere to strict non-promotional, confidentiality, and legal/compliance requirements.
Knowledge/Skills:
- Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCP offices.
- Ability to navigate payer portals, CRM/tools; strong training/relationship-building and analytical skills.
- Data/reporting tools to manage caseload; strategic business/account planning.
- Travel 50–70%; Microsoft Office (Outlook/Word/Excel/PowerPoint) and Salesforce CRM.
- Valid driver’s license; meet healthcare rep credentialing requirements.
Education/Experience:
- Bachelor’s in healthcare/life sciences/business (advanced degree a plus).
- 5+ years in sales/reimbursement/market access/specialty pharmacy/patient services/field access.
- Deep knowledge of benefits investigations, PA, appeals, coverage policies; Medicare/Medicaid/commercial.
Pay Range: $136,000–$204,000.
Benefits (as stated): annual bonus; annual equity awards; medical/dental/vision; paid time off; educational assistance (incl. student loan repayment); commuting subsidy; 401(k).
Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP), serving as local subject matter expert to nephrology practices to provide non-promotional access/reimbursement education and troubleshoot to support timely patient access to prescribed kidney therapies.
Key Duties and Responsibilities:
- Build compliant relationships with nephrology care teams and administrative staff (prior authorizations/patient access).
- Partner with case management to resolve escalated access issues and coordinate handoffs via CRM workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways.
- Follow up on case status and ensure offices meet insurance documentation requirements.
- Maintain understanding of commercial/government coverage requirements and payer trends.
- Deliver compliant on-site/virtual in-services and training on payer policies, formulary updates, PA/exception criteria, coding/billing (ICD-10, CPT), documentation, and reimbursement workflows (hub services, enrollment, distribution).
- Manage a multistate region, prioritize accounts by patient need/payer dynamics/KPSP demand, and develop territory engagement plans.
- Adhere to strict non-promotional, confidentiality, and legal/compliance requirements.
Knowledge/Skills:
- Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCP offices.
- Ability to navigate payer portals, CRM/tools; strong training/relationship-building and analytical skills.
- Data/reporting tools to manage caseload; strategic business/account planning.
- Travel 50–70%; Microsoft Office (Outlook/Word/Excel/PowerPoint) and Salesforce CRM.
- Valid driver’s license; meet healthcare rep credentialing requirements.
Education/Experience:
- Bachelor’s in healthcare/life sciences/business (advanced degree a plus).
- 5+ years in sales/reimbursement/market access/specialty pharmacy/patient services/field access.
- Deep knowledge of benefits investigations, PA, appeals, coverage policies; Medicare/Medicaid/commercial.
Pay Range: $136,000–$204,000.
Benefits (as stated): annual bonus; annual equity awards; medical/dental/vision; paid time off; educational assistance (incl. student loan repayment); commuting subsidy; 401(k).