Field Reimbursement Manager - Kidney (Tri-State - NY, PA, NJ)
Vertex Pharmaceuticals
July 01, 2026
On-site
New Jersey, United States
Market Access
General Summary:
- Field-based Field Reimbursement Manager in Vertex’s Kidney Patient Support Program (KPSP). Serve as local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education. Support timely patient access to prescribed Vertex kidney therapies through troubleshooting and territory-level payer expertise.
Key Duties And Responsibilities:
- Build compliant connections with nephrology office personnel (care team and staff handling prior authorizations/specialty medication access).
- Partner with case management to resolve escalated access issues; coordinate handoffs 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 understanding of commercial and government prescription insurance coverage requirements and payer trends.
- Conduct compliant on-site and virtual in-services/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.
- 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; comply with laws/regulations, confidentiality, and company policies; apply program business rules.
Knowledge And Skills:
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCP offices.
- Payer portal/CRM/tool navigation; strong communication/training/relationship-building; analytical skills; data/reporting for caseload prioritization.
- Strategic business/account plan experience; judgment/problem-solving.
- Travel 50–70% within territory; Microsoft Outlook/Word/Excel/PowerPoint/Salesforce CRM.
- Valid driver’s license; meet industry representative credentialing requirements.
Education And Experience:
- Bachelor’s degree in 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 processes, appeals, coverage policies, and payer ecosystems.
- Payer knowledge of Medicare, Medicaid, and commercial insurance.
Pay Range:
- $136,000 - $204,000
- Eligible for annual bonus and annual equity awards.
Application:
- Contact recruiter or hiring manager regarding accommodations; ApplicationAssistance@vrtx.com.
- Field-based Field Reimbursement Manager in Vertex’s Kidney Patient Support Program (KPSP). Serve as local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education. Support timely patient access to prescribed Vertex kidney therapies through troubleshooting and territory-level payer expertise.
Key Duties And Responsibilities:
- Build compliant connections with nephrology office personnel (care team and staff handling prior authorizations/specialty medication access).
- Partner with case management to resolve escalated access issues; coordinate handoffs 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 understanding of commercial and government prescription insurance coverage requirements and payer trends.
- Conduct compliant on-site and virtual in-services/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.
- 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; comply with laws/regulations, confidentiality, and company policies; apply program business rules.
Knowledge And Skills:
- Specialty biologics/rare disease/complex pharmacy benefit experience; account management with HCP offices.
- Payer portal/CRM/tool navigation; strong communication/training/relationship-building; analytical skills; data/reporting for caseload prioritization.
- Strategic business/account plan experience; judgment/problem-solving.
- Travel 50–70% within territory; Microsoft Outlook/Word/Excel/PowerPoint/Salesforce CRM.
- Valid driver’s license; meet industry representative credentialing requirements.
Education And Experience:
- Bachelor’s degree in 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 processes, appeals, coverage policies, and payer ecosystems.
- Payer knowledge of Medicare, Medicaid, and commercial insurance.
Pay Range:
- $136,000 - $204,000
- Eligible for annual bonus and annual equity awards.
Application:
- Contact recruiter or hiring manager regarding accommodations; ApplicationAssistance@vrtx.com.