Field Reimbursement Manager - Kidney (South Texas)
Vertex Pharmaceuticals
June 27, 2026
On-site
United States
Market Access
General Summary:
- Field-based Field Reimbursement Manager for Vertex Kidney Patient Support Program (KPSP), serving as a local subject matter expert to nephrology practices.
- Provide non-promotional access and reimbursement education; troubleshoot to support timely patient access.
Key Duties And Responsibilities:
- Establish compliant connections with nephrology office care team and administrative staff for prior authorizations and specialty medication access.
- Partner with case management to address escalated access issues; manage coordinated handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways; provide follow-up on case status and insurance documentation requirements.
- Maintain knowledge of commercial and government prescription coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies/formulary updates, PA/medical exception criteria, ICD-10/CPT coding and documentation, distribution pathways/hub services/enrollment and reimbursement workflows.
- Manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand; adapt engagement to office workflows.
- Develop territory engagement plans; adhere to non-promotional guidelines; maintain patient health information confidentiality.
Knowledge And Skills / Qualifications:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management experience with HCP offices; ability to navigate payer portals/CRM/field tools.
- Strong communication, training, relationship-building, analytical, and data/reporting skills.
- Experience developing/executing strategic account plans; sound judgment; travel 50–70%.
- Proficiency: Microsoft Outlook/Word/Excel/PowerPoint and Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education And Experience:
- Bachelor’s degree (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, and payer ecosystems; knowledge of Medicare/Medicaid/commercial plans.
- Field-based Field Reimbursement Manager for Vertex Kidney Patient Support Program (KPSP), serving as a local subject matter expert to nephrology practices.
- Provide non-promotional access and reimbursement education; troubleshoot to support timely patient access.
Key Duties And Responsibilities:
- Establish compliant connections with nephrology office care team and administrative staff for prior authorizations and specialty medication access.
- Partner with case management to address escalated access issues; manage coordinated handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and other affordability pathways; provide follow-up on case status and insurance documentation requirements.
- Maintain knowledge of commercial and government prescription coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies/formulary updates, PA/medical exception criteria, ICD-10/CPT coding and documentation, distribution pathways/hub services/enrollment and reimbursement workflows.
- Manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand; adapt engagement to office workflows.
- Develop territory engagement plans; adhere to non-promotional guidelines; maintain patient health information confidentiality.
Knowledge And Skills / Qualifications:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management experience with HCP offices; ability to navigate payer portals/CRM/field tools.
- Strong communication, training, relationship-building, analytical, and data/reporting skills.
- Experience developing/executing strategic account plans; sound judgment; travel 50–70%.
- Proficiency: Microsoft Outlook/Word/Excel/PowerPoint and Salesforce CRM.
- Valid driver’s license; meet healthcare representative credentialing requirements.
Education And Experience:
- Bachelor’s degree (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, and payer ecosystems; knowledge of Medicare/Medicaid/commercial plans.