Field Reimbursement Manager - Kidney (Pacific Northwest - WA, OR, ID, WY, MT, AK)
Vertex Pharmaceuticals
June 27, 2026
On-site
Oregon, United States
Market Access
General Summary (role): 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 and reimbursement education and support timely patient access via troubleshooting and payer expertise.
Key Duties & Responsibilities:
- Build compliant relationships with nephrology office staff (care team + prior authorization/patient access) to support access to prescribed specialty medications.
- 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; provide case-status follow-up and clarify insurance documentation requirements.
- Maintain understanding of commercial/government coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, formulary/coverage nuances, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation, distribution/hub services, enrollment, and reimbursement workflows.
- Manage a multi-state territory independently; develop territory engagement plans to reduce access barriers.
- Follow strict non-promotional, compliant/legal/privacy guidelines and maintain patient PHI confidentiality.
Knowledge/Skills/Requirements:
- Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCPs/office staff.
- Payer portal/CRM tool navigation; strong communication, training, relationship-building, and analytical/reporting skills.
- Strategic business/account planning; sound judgment.
- Travel 50–70%; MS Office and Salesforce CRM; valid driver’s license and credentialing.
Education/Experience:
- Bachelor’s degree (health care/life sciences/business); 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field access roles.
- Deep knowledge of PA, appeals, coverage policies; Medicare/Medicaid/commercial payer expertise.
Compensation/Benefits:
- Pay range: $136,000–$204,000; eligible for annual bonus and annual equity.
- Benefits include medical/dental/vision, paid time off (incl. summer/winter shutdown), educational assistance/student loan repayment, commuting subsidy, charitable donation matching, 401(k), and more.
Application Instructions:
- For application-process accommodation: ApplicationAssistance@vrtx.com.
Key Duties & Responsibilities:
- Build compliant relationships with nephrology office staff (care team + prior authorization/patient access) to support access to prescribed specialty medications.
- 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; provide case-status follow-up and clarify insurance documentation requirements.
- Maintain understanding of commercial/government coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, formulary/coverage nuances, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation, distribution/hub services, enrollment, and reimbursement workflows.
- Manage a multi-state territory independently; develop territory engagement plans to reduce access barriers.
- Follow strict non-promotional, compliant/legal/privacy guidelines and maintain patient PHI confidentiality.
Knowledge/Skills/Requirements:
- Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCPs/office staff.
- Payer portal/CRM tool navigation; strong communication, training, relationship-building, and analytical/reporting skills.
- Strategic business/account planning; sound judgment.
- Travel 50–70%; MS Office and Salesforce CRM; valid driver’s license and credentialing.
Education/Experience:
- Bachelor’s degree (health care/life sciences/business); 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field access roles.
- Deep knowledge of PA, appeals, coverage policies; Medicare/Medicaid/commercial payer expertise.
Compensation/Benefits:
- Pay range: $136,000–$204,000; eligible for annual bonus and annual equity.
- Benefits include medical/dental/vision, paid time off (incl. summer/winter shutdown), educational assistance/student loan repayment, commuting subsidy, charitable donation matching, 401(k), and more.
Application Instructions:
- For application-process accommodation: ApplicationAssistance@vrtx.com.