Field Reimbursement Manager - Kidney (South Texas)
Vertex Pharmaceuticals
June 27, 2026
On-site
Texas, United States
Market Access
Field Reimbursement Manager (Kidney Patient Support Program)
General Summary:
- Field-based subject matter expert to nephrology practices providing non-promotional access and reimbursement education; troubleshoot to support timely patient access to prescribed Vertex kidney therapies.
Key Duties & Responsibilities:
- Build compliant relationships with nephrology office personnel (care team and prior authorization/patient access staff).
- Coordinate with case management on escalated access issues using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways.
- Follow up on case status; ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government insurance coverage requirements and payer trends.
- Deliver on-site/virtual in-services and training on payer policies, formulary/coverage nuances, PA/medical exceptions, coding/billing (ICD-10/CPT), documentation, and reimbursement workflows/hub services/enrollment.
- Independently manage a multistate region; prioritize accounts by patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to reduce access barriers; adhere to non-promotional compliance and patient confidentiality.
Knowledge & Skills:
- Specialty biologics/rare disease/compex pharmacy benefit experience; account management with HCP offices.
- Payer portal/CRM navigation; strong communication, training, analytics, and data/reporting skills.
- Ability to travel 50–70%; Microsoft Office and Salesforce CRM proficiency.
- Valid driver’s license and facility credentialing.
Education & Experience:
- Bachelor’s degree (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, and coverage/payer ecosystems; Medicare/Medicaid/commercial knowledge.
Pay Range:
- $136,000–$204,000. Eligible for annual bonus and annual equity.
Benefits (as stated):
- Medical/dental/vision; paid time off (incl. summer/winter shutdown); educational assistance (incl. student loan repayment); commuting subsidy; matching charitable donations; 401(k).
Application Instructions:
- For accommodation related to hiring, contact ApplicationAssistance@vrtx.com.
General Summary:
- Field-based subject matter expert to nephrology practices providing non-promotional access and reimbursement education; troubleshoot to support timely patient access to prescribed Vertex kidney therapies.
Key Duties & Responsibilities:
- Build compliant relationships with nephrology office personnel (care team and prior authorization/patient access staff).
- Coordinate with case management on escalated access issues using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways.
- Follow up on case status; ensure offices understand insurance documentation requirements.
- Maintain knowledge of commercial and government insurance coverage requirements and payer trends.
- Deliver on-site/virtual in-services and training on payer policies, formulary/coverage nuances, PA/medical exceptions, coding/billing (ICD-10/CPT), documentation, and reimbursement workflows/hub services/enrollment.
- Independently manage a multistate region; prioritize accounts by patient need, payer dynamics, and KPSP demand.
- Develop territory engagement plans to reduce access barriers; adhere to non-promotional compliance and patient confidentiality.
Knowledge & Skills:
- Specialty biologics/rare disease/compex pharmacy benefit experience; account management with HCP offices.
- Payer portal/CRM navigation; strong communication, training, analytics, and data/reporting skills.
- Ability to travel 50–70%; Microsoft Office and Salesforce CRM proficiency.
- Valid driver’s license and facility credentialing.
Education & Experience:
- Bachelor’s degree (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, and coverage/payer ecosystems; Medicare/Medicaid/commercial knowledge.
Pay Range:
- $136,000–$204,000. Eligible for annual bonus and annual equity.
Benefits (as stated):
- Medical/dental/vision; paid time off (incl. summer/winter shutdown); educational assistance (incl. student loan repayment); commuting subsidy; matching charitable donations; 401(k).
Application Instructions:
- For accommodation related to hiring, contact ApplicationAssistance@vrtx.com.