Field Reimbursement Manager - Kidney (OH-PA)
Vertex Pharmaceuticals
August 09, 2026
Remote friendly (United States)
United States
Market Access
Field Reimbursement Manager (Kidney Patient Support Program, KPSP)
General Summary:
Field-based subject matter expert to nephrology practices, providing non-promotional access and reimbursement education and troubleshooting to support timely patient access to prescribed Vertex kidney therapies.
Key Duties and Responsibilities:
- Build compliant relationships with nephrology office personnel (care team and prior authorization/patient access staff).
- Partner with case management on escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways.
- Follow up on case status and ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government prescription insurance requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, formulary updates, coverage nuances, PA/medical exceptions, coding/billing (ICD-10, CPT), documentation, and distribution/hub/enrollment/reimbursement workflows.
- Manage a multistate region independently; prioritize accounts by patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans; minimize patient-specific access barriers.
- Follow strict non-promotional guidelines; maintain confidentiality and comply with applicable laws/regulations and company policies.
Knowledge and Skills / Qualifications:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products; account management with HCP offices.
- Ability to navigate payer portals and CRM/field access tools; strong training/relationship and analytical/reporting skills.
- Ability to travel 50–70%; valid driver’s license; meet facility credentialing requirements.
- Proficiency: Outlook, Word, Excel, PowerPoint, Salesforce CRM.
- Bachelor’s degree (health care/life sciences/business); 5+ years in sales/reimbursement/market access/specialty pharmacy/patient services/field-based access.
- Deep understanding of benefits investigations, PA processes, appeals, and Medicare/Medicaid/commercial coverage.
Pay Range:
- $136,000–$204,000; eligible for annual bonus and annual equity awards.
General Summary:
Field-based subject matter expert to nephrology practices, providing non-promotional access and reimbursement education and troubleshooting to support timely patient access to prescribed Vertex kidney therapies.
Key Duties and Responsibilities:
- Build compliant relationships with nephrology office personnel (care team and prior authorization/patient access staff).
- Partner with case management on escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways.
- Follow up on case status and ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government prescription insurance requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, formulary updates, coverage nuances, PA/medical exceptions, coding/billing (ICD-10, CPT), documentation, and distribution/hub/enrollment/reimbursement workflows.
- Manage a multistate region independently; prioritize accounts by patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans; minimize patient-specific access barriers.
- Follow strict non-promotional guidelines; maintain confidentiality and comply with applicable laws/regulations and company policies.
Knowledge and Skills / Qualifications:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products; account management with HCP offices.
- Ability to navigate payer portals and CRM/field access tools; strong training/relationship and analytical/reporting skills.
- Ability to travel 50–70%; valid driver’s license; meet facility credentialing requirements.
- Proficiency: Outlook, Word, Excel, PowerPoint, Salesforce CRM.
- Bachelor’s degree (health care/life sciences/business); 5+ years in sales/reimbursement/market access/specialty pharmacy/patient services/field-based access.
- Deep understanding of benefits investigations, PA processes, appeals, and Medicare/Medicaid/commercial coverage.
Pay Range:
- $136,000–$204,000; eligible for annual bonus and annual equity awards.