Field Reimbursement Manager - Kidney (Southeast - AL, GA, FL)
Vertex Pharmaceuticals
June 27, 2026
On-site
Florida, United States
Market Access
General Summary:
Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP). Serve as a local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education, and support timely patient access through troubleshooting and territory payer expertise.
Key Duties and Responsibilities:
- Build compliant connections with nephrology office personnel involved in prior authorizations and specialty medication access.
- Partner with case management to address escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways; provide timely case-status follow-up and clarify insurance documentation requirements.
- Maintain knowledge of commercial and government prescription insurance coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, formulary updates, coverage nuances, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation, distribution pathways, hub services, enrollment, and reimbursement workflows.
- Manage a multistate region; prioritize accounts by patient need, payer dynamics, and KPSP demand; develop territory engagement plans.
- Follow strict non-promotional guidelines; maintain patient confidentiality and comply with laws/regulations/policies.
Knowledge and Skills / Qualifications:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management experience with HCPs/office staff; ability to navigate payer portals, CRM systems, and field tools.
- Strong communication/training/relationship-building and analytical skills; ability to use data/reporting tools to manage caseload.
- Experience developing/executing strategic account plans; good judgment in decision-making.
- Travel 50–70% within territory; proficiency in Outlook/Word/Excel/PowerPoint/Salesforce CRM.
- Valid driver’s license and ability to meet credentialing requirements for facility access.
Education and Experience:
- Bachelor’s degree in healthcare, life sciences, or business (advanced degree 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; payer knowledge including Medicare/Medicaid/commercial.
Pay Range: $136,000 - $204,000 (annual bonus and annual equity awards; overtime may apply).
Application Instructions: Contact recruiter/hiring manager or Talent Acquisition at ApplicationAssistance@vrtx.com for application accommodations.
Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP). Serve as a local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education, and support timely patient access through troubleshooting and territory payer expertise.
Key Duties and Responsibilities:
- Build compliant connections with nephrology office personnel involved in prior authorizations and specialty medication access.
- Partner with case management to address escalated access issues; coordinate handoffs using CRM triggers/workflows.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways; provide timely case-status follow-up and clarify insurance documentation requirements.
- Maintain knowledge of commercial and government prescription insurance coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies, formulary updates, coverage nuances, PA/medical exception criteria, coding/billing (ICD-10, CPT), documentation, distribution pathways, hub services, enrollment, and reimbursement workflows.
- Manage a multistate region; prioritize accounts by patient need, payer dynamics, and KPSP demand; develop territory engagement plans.
- Follow strict non-promotional guidelines; maintain patient confidentiality and comply with laws/regulations/policies.
Knowledge and Skills / Qualifications:
- Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products.
- Account management experience with HCPs/office staff; ability to navigate payer portals, CRM systems, and field tools.
- Strong communication/training/relationship-building and analytical skills; ability to use data/reporting tools to manage caseload.
- Experience developing/executing strategic account plans; good judgment in decision-making.
- Travel 50–70% within territory; proficiency in Outlook/Word/Excel/PowerPoint/Salesforce CRM.
- Valid driver’s license and ability to meet credentialing requirements for facility access.
Education and Experience:
- Bachelor’s degree in healthcare, life sciences, or business (advanced degree 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; payer knowledge including Medicare/Medicaid/commercial.
Pay Range: $136,000 - $204,000 (annual bonus and annual equity awards; overtime may apply).
Application Instructions: Contact recruiter/hiring manager or Talent Acquisition at ApplicationAssistance@vrtx.com for application accommodations.