Field Reimbursement Manager - Kidney (South Central - AR, MS, LA, TN)
Vertex Pharmaceuticals
June 25, 2026
On-site
Tennessee, United States
Market Access
Field Reimbursement Manager (Kidney Patient Support Program, KPSP)
Responsibilities:
- Build compliant relationships with nephrology office staff (care team and prior authorization/patient access administrators) to support access to prescribed specialty medications.
- Partner with case management to resolve escalated access issues; manage coordinated handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways; provide case status follow-up and ensure documentation requirements are met.
- Maintain knowledge of commercial and government coverage requirements and payer trends.
- Deliver compliant on-site/virtual in-services and training on payer policies, formulary/coverage nuances, PA/medical exception criteria, ICD-10/CPT, documentation, distribution/hub services, enrollment, and reimbursement workflows.
- Manage a multistate territory independently; prioritize accounts by patient need, payer dynamics, and KPSP demand; create territory engagement plans.
- Adhere to strict non-promotional and privacy/compliance expectations; maintain patient confidentiality.
Knowledge/Skills:
- Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCP offices.
- Payer portal/CRM/tool navigation; strong communication/training/relationship-building.
- Analytical skills and ability to use data/reporting to prioritize caseload.
- Travel 50–70%; proficiency in Outlook/Word/Excel/PowerPoint/Salesforce CRM; valid driver’s license and credentialing.
Education/Experience:
- BS in healthcare/life sciences/business (advanced degree preferred).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep understanding of benefits investigations, PA, appeals, coverage policies, and payer ecosystems; knowledge of Medicare/Medicaid/commercial.
Compensation/Benefits:
- Pay range: $136,000–$204,000; eligible for annual bonus and annual equity; may be eligible for overtime; comprehensive benefits incl. medical/dental/vision, paid time off, 401(k), and educational assistance.
Responsibilities:
- Build compliant relationships with nephrology office staff (care team and prior authorization/patient access administrators) to support access to prescribed specialty medications.
- Partner with case management to resolve escalated access issues; manage coordinated handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways; provide case status follow-up and ensure documentation requirements are met.
- Maintain knowledge of commercial and government coverage requirements and payer trends.
- Deliver compliant on-site/virtual in-services and training on payer policies, formulary/coverage nuances, PA/medical exception criteria, ICD-10/CPT, documentation, distribution/hub services, enrollment, and reimbursement workflows.
- Manage a multistate territory independently; prioritize accounts by patient need, payer dynamics, and KPSP demand; create territory engagement plans.
- Adhere to strict non-promotional and privacy/compliance expectations; maintain patient confidentiality.
Knowledge/Skills:
- Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCP offices.
- Payer portal/CRM/tool navigation; strong communication/training/relationship-building.
- Analytical skills and ability to use data/reporting to prioritize caseload.
- Travel 50–70%; proficiency in Outlook/Word/Excel/PowerPoint/Salesforce CRM; valid driver’s license and credentialing.
Education/Experience:
- BS in healthcare/life sciences/business (advanced degree preferred).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access.
- Deep understanding of benefits investigations, PA, appeals, coverage policies, and payer ecosystems; knowledge of Medicare/Medicaid/commercial.
Compensation/Benefits:
- Pay range: $136,000–$204,000; eligible for annual bonus and annual equity; may be eligible for overtime; comprehensive benefits incl. medical/dental/vision, paid time off, 401(k), and educational assistance.