Field Reimbursement Manager - Kidney (South Florida)
Vertex Pharmaceuticals
June 27, 2026
On-site
United States
Market Access
Key Duties And Responsibilities:
- Compliantly establish connections with nephrology office personnel to support patient access to prescribed specialty medications.
- Partner with case management to address escalated access issues; ensure coordinated handoffs using CRM triggers/workflows.
- Support timely patient access by educating offices on copay, PAP, Bridge programs, and other affordability pathways.
- Provide timely follow-up on case status; ensure offices understand insurance documentation requirements.
- Maintain understanding of commercial and government prescription insurance coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on regional payer policies, formulary updates, coverage nuances, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation requirements, distribution pathways, hub services, enrollment processes, and reimbursement workflows.
- Independently manage a multistate region; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize patient-specific access barriers.
- Adhere to strict non-promotional guidelines; maintain confidentiality of patient health information and comply with laws/regulations/policies.
Knowledge And Skills:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCP offices; navigate payer portals, CRM systems, and field access tools.
- Strong communication/training/relationship-building and analytical/data reporting skills.
- Ability to develop/execute strategic business/account plans; exercise judgment in problem solving.
- Travel 50–70% within assigned territory; valid driver’s license.
- Proficient in Microsoft Outlook/Word/Excel/PowerPoint and Salesforce CRM.
Education And Experience:
- Bachelor’s degree in health care, life sciences, or business (advanced degree is 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, and payer ecosystems.
- In-depth knowledge of Medicare, Medicaid, and commercial insurance plans.
Pay/Benefits:
- Pay range: $136,000–$204,000.
- Eligible for annual bonus and annual equity awards; may be eligible for overtime pay.
- Total Rewards may include medical/dental/vision, paid time off (including summer/winter shutdown), educational assistance/student loan repayment, commuting subsidy, charitable donation matching, 401(k), and more.
Application Instructions:
- Apply (include accommodation requests as needed): ApplicationAssistance@vrtx.com.
- Compliantly establish connections with nephrology office personnel to support patient access to prescribed specialty medications.
- Partner with case management to address escalated access issues; ensure coordinated handoffs using CRM triggers/workflows.
- Support timely patient access by educating offices on copay, PAP, Bridge programs, and other affordability pathways.
- Provide timely follow-up on case status; ensure offices understand insurance documentation requirements.
- Maintain understanding of commercial and government prescription insurance coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on regional payer policies, formulary updates, coverage nuances, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation requirements, distribution pathways, hub services, enrollment processes, and reimbursement workflows.
- Independently manage a multistate region; prioritize accounts based on patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to minimize patient-specific access barriers.
- Adhere to strict non-promotional guidelines; maintain confidentiality of patient health information and comply with laws/regulations/policies.
Knowledge And Skills:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management with HCP offices; navigate payer portals, CRM systems, and field access tools.
- Strong communication/training/relationship-building and analytical/data reporting skills.
- Ability to develop/execute strategic business/account plans; exercise judgment in problem solving.
- Travel 50–70% within assigned territory; valid driver’s license.
- Proficient in Microsoft Outlook/Word/Excel/PowerPoint and Salesforce CRM.
Education And Experience:
- Bachelor’s degree in health care, life sciences, or business (advanced degree is 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, and payer ecosystems.
- In-depth knowledge of Medicare, Medicaid, and commercial insurance plans.
Pay/Benefits:
- Pay range: $136,000–$204,000.
- Eligible for annual bonus and annual equity awards; may be eligible for overtime pay.
- Total Rewards may include medical/dental/vision, paid time off (including summer/winter shutdown), educational assistance/student loan repayment, commuting subsidy, charitable donation matching, 401(k), and more.
Application Instructions:
- Apply (include accommodation requests as needed): ApplicationAssistance@vrtx.com.