Field Reimbursement Manager - Kidney (NYC Metro)
Vertex Pharmaceuticals
June 27, 2026
On-site
United States
Market Access
Role: Field Reimbursement Manager (Kidney Patient Support Program)
Responsibilities:
- Build compliant connections with nephrology office personnel to support patient access to specialty medications (including prior authorization/admin staff).
- Partner with case management to resolve escalated access issues using CRM triggers/workflows.
- Educate offices on copay assistance, PAP, Bridge programs, and affordability pathways.
- Provide follow-up on case status and ensure understanding of insurance documentation requirements.
- Maintain knowledge of commercial and government prescription insurance coverage requirements and payer trends.
- Deliver compliant on-site/virtual in-services and training on payer policies/formulary updates, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation, distribution pathways, hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and program demand.
- Develop territory engagement plans to minimize patient-specific access barriers.
- Follow non-promotional guidelines; maintain patient confidentiality and comply with applicable laws/regulations and company policies.
Qualifications/Skills:
- 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.
- Proficiency navigating payer portals, CRM systems, and field access tools; strong training/relationship-building skills.
- Strong analytical skills; ability to use data/reporting tools to manage caseload and prioritize.
- Travel 50–70%.
- Bachelor’s degree (health care/life sciences/business); advanced degree a plus.
- Proficiency: MS Outlook/Word/Excel/PowerPoint; Salesforce CRM; valid driver’s license; credentialing for facility access.
Pay/Benefits:
- $136,000–$204,000; eligible for annual bonus and annual equity.
- Medical/dental/vision, paid time off, educational assistance (incl. student loan repayment), commuting subsidy, matching charitable donations, 401(k).
Application: Contact Talent Acquisition at ApplicationAssistance@vrtx.com for application assistance/accommodations.
Responsibilities:
- Build compliant connections with nephrology office personnel to support patient access to specialty medications (including prior authorization/admin staff).
- Partner with case management to resolve escalated access issues using CRM triggers/workflows.
- Educate offices on copay assistance, PAP, Bridge programs, and affordability pathways.
- Provide follow-up on case status and ensure understanding of insurance documentation requirements.
- Maintain knowledge of commercial and government prescription insurance coverage requirements and payer trends.
- Deliver compliant on-site/virtual in-services and training on payer policies/formulary updates, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation, distribution pathways, hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and program demand.
- Develop territory engagement plans to minimize patient-specific access barriers.
- Follow non-promotional guidelines; maintain patient confidentiality and comply with applicable laws/regulations and company policies.
Qualifications/Skills:
- 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.
- Proficiency navigating payer portals, CRM systems, and field access tools; strong training/relationship-building skills.
- Strong analytical skills; ability to use data/reporting tools to manage caseload and prioritize.
- Travel 50–70%.
- Bachelor’s degree (health care/life sciences/business); advanced degree a plus.
- Proficiency: MS Outlook/Word/Excel/PowerPoint; Salesforce CRM; valid driver’s license; credentialing for facility access.
Pay/Benefits:
- $136,000–$204,000; eligible for annual bonus and annual equity.
- Medical/dental/vision, paid time off, educational assistance (incl. student loan repayment), commuting subsidy, matching charitable donations, 401(k).
Application: Contact Talent Acquisition at ApplicationAssistance@vrtx.com for application assistance/accommodations.