Field Reimbursement Manager - Kidney (OH-PA)
Vertex Pharmaceuticals
June 27, 2026
On-site
United States
Market Access
Field Reimbursement Manager (Kidney Patient Support Program - KPSP)
Key Duties And Responsibilities:
- Establish compliant relationships with nephrology office care teams and prior authorization/access staff to support access to prescribed specialty medications.
- Partner with case management to resolve escalated access issues; ensure coordinated handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways; provide timely follow-up on case status and documentation requirements.
- Maintain understanding of commercial/government prescription coverage requirements, payer trends, and PA/medical exception processes.
- Conduct compliant on-site/virtual in-services and training on payer policies, formulary updates, PA/exception criteria, coding/billing (ICD-10, CPT), documentation, distribution/hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate region; prioritize accounts by patient need, payer dynamics, and KPSP demand; develop territory engagement plans.
- Adhere to strict non-promotional guidelines; maintain confidentiality of patient health information.
Knowledge/Skills/Qualifications:
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCPs/office staff.
- Proficiency navigating payer portals, CRM and field access tools; strong communication/training/relationship building; analytical and data/reporting skills.
- Ability to travel 50–70%; valid driver’s license; meet credentialing requirements for facility access.
- Proficiency: Microsoft Outlook/Word/Excel/PowerPoint; Salesforce CRM.
Education/Experience:
- Bachelor’s degree (health care, life sciences, or 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, coverage policies; payer knowledge (Medicare/Medicaid/commercial).
Compensation/Benefits (as stated):
- Pay range: $136,000–$204,000; eligible for annual bonus and annual equity.
- Benefits include medical/dental/vision, generous PTO (incl. summer/winter shutdown), educational assistance/student loan repayment, commuting subsidy, matching charitable donations, and 401(k).
Key Duties And Responsibilities:
- Establish compliant relationships with nephrology office care teams and prior authorization/access staff to support access to prescribed specialty medications.
- Partner with case management to resolve escalated access issues; ensure coordinated handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways; provide timely follow-up on case status and documentation requirements.
- Maintain understanding of commercial/government prescription coverage requirements, payer trends, and PA/medical exception processes.
- Conduct compliant on-site/virtual in-services and training on payer policies, formulary updates, PA/exception criteria, coding/billing (ICD-10, CPT), documentation, distribution/hub services, enrollment, and reimbursement workflows.
- Independently manage a multistate region; prioritize accounts by patient need, payer dynamics, and KPSP demand; develop territory engagement plans.
- Adhere to strict non-promotional guidelines; maintain confidentiality of patient health information.
Knowledge/Skills/Qualifications:
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCPs/office staff.
- Proficiency navigating payer portals, CRM and field access tools; strong communication/training/relationship building; analytical and data/reporting skills.
- Ability to travel 50–70%; valid driver’s license; meet credentialing requirements for facility access.
- Proficiency: Microsoft Outlook/Word/Excel/PowerPoint; Salesforce CRM.
Education/Experience:
- Bachelor’s degree (health care, life sciences, or 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, coverage policies; payer knowledge (Medicare/Medicaid/commercial).
Compensation/Benefits (as stated):
- Pay range: $136,000–$204,000; eligible for annual bonus and annual equity.
- Benefits include medical/dental/vision, generous PTO (incl. summer/winter shutdown), educational assistance/student loan repayment, commuting subsidy, matching charitable donations, and 401(k).