Field Reimbursement Manager - Kidney (OH-PA)
Vertex Pharmaceuticals
June 27, 2026
On-site
Ohio, United States
Market Access
Field Reimbursement Manager (Kidney Patient Support Program – KPSP)
Key Duties and Responsibilities
- Build compliant relationships with nephrology office care and administrative teams (prior authorization/patient access) to support access to prescribed specialty medications.
- Partner with case management to resolve escalated access issues; coordinate handoffs using CRM triggers/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 insurance coverage requirements, payer trends, and access requirements.
- Conduct on-site/virtual in-services and training using approved payer guides and tools on: payer policies/formulary updates; PA/medical exception criteria; coding/billing (ICD-10, CPT) and documentation; distribution pathways/hub services/enrollment/reimbursement workflows.
- Independently manage a multistate region; prioritize accounts based on patient need, payer dynamics, and KPSP demand; minimize workflow disruption.
- Develop territory engagement plans; adhere to non-promotional, privacy, and compliance requirements.
- Maintain confidentiality of patient health information and comply with laws/regulations and company policies.
Knowledge/Skills
- Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCP offices.
- Payer portal/CRM/tool proficiency; strong training/relationship-building and analytical skills.
- Data/reporting ability to manage caseload; strategic business/account planning.
- Travel 50–70% within territory; Microsoft Office (Outlook/Word/Excel/PowerPoint) and Salesforce CRM.
- Valid driver’s license; meet credentialing requirements.
Education/Experience
- Bachelor’s in health care/life sciences/business (advanced degree preferred).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles.
- Deep understanding of benefits investigations, PA/appeals, coverage policies; payer knowledge (Medicare/Medicaid/commercial).
Compensation/Benefits
- Pay range: $136,000–$204,000. Eligible for annual bonus and annual equity awards; other overtime eligibility may apply.
Key Duties and Responsibilities
- Build compliant relationships with nephrology office care and administrative teams (prior authorization/patient access) to support access to prescribed specialty medications.
- Partner with case management to resolve escalated access issues; coordinate handoffs using CRM triggers/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 insurance coverage requirements, payer trends, and access requirements.
- Conduct on-site/virtual in-services and training using approved payer guides and tools on: payer policies/formulary updates; PA/medical exception criteria; coding/billing (ICD-10, CPT) and documentation; distribution pathways/hub services/enrollment/reimbursement workflows.
- Independently manage a multistate region; prioritize accounts based on patient need, payer dynamics, and KPSP demand; minimize workflow disruption.
- Develop territory engagement plans; adhere to non-promotional, privacy, and compliance requirements.
- Maintain confidentiality of patient health information and comply with laws/regulations and company policies.
Knowledge/Skills
- Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCP offices.
- Payer portal/CRM/tool proficiency; strong training/relationship-building and analytical skills.
- Data/reporting ability to manage caseload; strategic business/account planning.
- Travel 50–70% within territory; Microsoft Office (Outlook/Word/Excel/PowerPoint) and Salesforce CRM.
- Valid driver’s license; meet credentialing requirements.
Education/Experience
- Bachelor’s in health care/life sciences/business (advanced degree preferred).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles.
- Deep understanding of benefits investigations, PA/appeals, coverage policies; payer knowledge (Medicare/Medicaid/commercial).
Compensation/Benefits
- Pay range: $136,000–$204,000. Eligible for annual bonus and annual equity awards; other overtime eligibility may apply.