Field Reimbursement Manager - Kidney (Tri-State - NY, PA, NJ)
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 local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education, troubleshooting to support timely patient access.
Key Duties And Responsibilities:
- Build compliant relationships with nephrology office personnel (care team and prior authorization/patient access staff) to support access to prescribed medications.
- Partner with case management to resolve escalated access issues; use CRM triggers/workflows for handoffs.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways; provide case follow-up and explain insurance documentation requirements.
- Maintain knowledge of commercial and government insurance coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies/formulary updates; PA/medical exception criteria; coding/billing (ICD-10, CPT); distribution pathways/hub services/enrollment and reimbursement workflows.
- Manage a multistate region independently; develop territory engagement plans to reduce patient access barriers.
- Follow strict non-promotional, compliance/privacy guidelines; maintain patient confidentiality and legal/regulatory compliance.
Knowledge And Skills:
- Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCP offices.
- Ability to navigate payer portals/CRM/tools; strong training/relationship-building and analytical skills.
- Data/reporting ability for caseload prioritization; results-driven; strategic account planning.
- Travel 50–70%; Microsoft Outlook/Word/Excel/PowerPoint; Salesforce CRM; valid driver’s license; credentialing for facility entry.
Education And Experience:
- Bachelor’s in health care/life sciences/business (advanced degree a plus).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field access.
- Deep knowledge of benefits investigations, PA, appeals, coverage policies, and Medicare/Medicaid/commercial.
Pay Range: $136,000–$204,000.
Benefits (as stated): annual bonus, annual equity awards; medical/dental/vision, paid time off, educational assistance/student loan repayment, commuting subsidy, charitable matching, 401(k).
Field-based Field Reimbursement Manager for Vertex Kidney Patient Support Program (KPSP) serving as local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education, troubleshooting to support timely patient access.
Key Duties And Responsibilities:
- Build compliant relationships with nephrology office personnel (care team and prior authorization/patient access staff) to support access to prescribed medications.
- Partner with case management to resolve escalated access issues; use CRM triggers/workflows for handoffs.
- Educate offices on copay, PAP, Bridge programs, and affordability pathways; provide case follow-up and explain insurance documentation requirements.
- Maintain knowledge of commercial and government insurance coverage requirements and payer trends.
- Conduct on-site/virtual in-services and training on payer policies/formulary updates; PA/medical exception criteria; coding/billing (ICD-10, CPT); distribution pathways/hub services/enrollment and reimbursement workflows.
- Manage a multistate region independently; develop territory engagement plans to reduce patient access barriers.
- Follow strict non-promotional, compliance/privacy guidelines; maintain patient confidentiality and legal/regulatory compliance.
Knowledge And Skills:
- Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCP offices.
- Ability to navigate payer portals/CRM/tools; strong training/relationship-building and analytical skills.
- Data/reporting ability for caseload prioritization; results-driven; strategic account planning.
- Travel 50–70%; Microsoft Outlook/Word/Excel/PowerPoint; Salesforce CRM; valid driver’s license; credentialing for facility entry.
Education And Experience:
- Bachelor’s in health care/life sciences/business (advanced degree a plus).
- 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field access.
- Deep knowledge of benefits investigations, PA, appeals, coverage policies, and Medicare/Medicaid/commercial.
Pay Range: $136,000–$204,000.
Benefits (as stated): annual bonus, annual equity awards; medical/dental/vision, paid time off, educational assistance/student loan repayment, commuting subsidy, charitable matching, 401(k).