Field Reimbursement Manager - Kidney (Central Southwest - AZ, NM, TX, OK)
Job Overview
Employment Type
Full-time
Compensation
Salary
Range $136,000.00 - $204,000.00
Work Schedule
Standard Hours
Benefits
Medical insurance
Dental Insurance
Vision Insurance
Paid Time Off
educational assistance
Commuter subsidy
401(k) Plan
Job Description
Vertex is a leading global biotechnology company dedicated to investing in scientific innovation to develop transformative therapies for serious diseases. Known for its commitment to advancing patient care, Vertex focuses on breakthrough treatments that address unmet medical needs, particularly in rare and complex conditions. With a strong presence worldwide, the company fosters an inclusive and supportive work environment that values diversity, equal opportunity, and employee growth. Vertex offers competitive compensation, comprehensive benefits, and career development opportunities to its workforce. The company is preparing to expand its portfolio with the potential commercialization of investigational therapeutics aimed at treating Immunoglobulin A nephropathy (IgAN), additional B cell-mediated diseases, and various genetic kidney disorders. To support this critical mission, Vertex is building a specialized field reimbursement team designed to facilitate patient access and ensure smooth navigation of complex reimbursement pathways.
The Field Reimbursement Manager role within the Kidney Patient Support Program (KPSP) is pivotal to Vertex's efforts in supporting patients living with serious kidney diseases. This field-based position involves acting as a local subject matter expert for nephrology practices, delivering non-promotional access and reimbursement education that helps healthcare providers understand and manage access to innovative kidney therapies. The Field Reimbursement Manager will be responsible for liaising closely with nephrology office staff, including care teams and administrative personnel, to ensure patients receive timely access to prescribed Vertex medications. This requires a strong understanding of insurance processes, commercial and government payer regulations, and effective troubleshooting skills to overcome payer-related challenges.
In this role, the manager will serve as a key resource for nephrology offices by educating them on copay assistance, patient assistance programs (PAP), Bridge programs, and other affordability options. Regular follow-up on case status and guidance on insurance documentation requirements is essential to maintaining smooth patient access workflows. The position also entails conducting both onsite and virtual trainings and in-services to communicate regional payer policies, formulary updates, prior authorization criteria, coding and billing requirements, as well as distribution and reimbursement procedures.
The ideal candidate will independently manage a multistate territory, prioritizing accounts according to patient need, payer dynamics, and program demand. They will develop territory-specific engagement strategies tailored to local payer landscapes and practice resources, always adhering strictly to non-promotional and compliance guidelines to safeguard patient confidentiality and legal standards.
This role requires significant travel within the assigned territory—typically between 50 to 70 percent—ensuring thorough coverage and relationship building across key nephrology stakeholders. The Field Reimbursement Manager must exhibit strong communication, analytical, and strategic planning skills, with proficiency in CRM systems and various data tools to manage caseloads effectively.
Vertex offers a competitive salary range of $136,000 to $204,000, coupled with eligibility for annual bonuses and equity awards. Emphasizing a robust total rewards program, Vertex provides market-leading benefits tailored to support employees throughout their professional and personal lives, including medical, dental, and vision coverage, paid time off with seasonal shutdowns, educational assistance, commuter subsidies, matching charitable donations, and a 401(k) plan. This opportunity represents a chance to join a dynamic and mission-driven team at the forefront of kidney disease therapy development, where the work directly impacts the lives of patients nationwide.
The Field Reimbursement Manager role within the Kidney Patient Support Program (KPSP) is pivotal to Vertex's efforts in supporting patients living with serious kidney diseases. This field-based position involves acting as a local subject matter expert for nephrology practices, delivering non-promotional access and reimbursement education that helps healthcare providers understand and manage access to innovative kidney therapies. The Field Reimbursement Manager will be responsible for liaising closely with nephrology office staff, including care teams and administrative personnel, to ensure patients receive timely access to prescribed Vertex medications. This requires a strong understanding of insurance processes, commercial and government payer regulations, and effective troubleshooting skills to overcome payer-related challenges.
In this role, the manager will serve as a key resource for nephrology offices by educating them on copay assistance, patient assistance programs (PAP), Bridge programs, and other affordability options. Regular follow-up on case status and guidance on insurance documentation requirements is essential to maintaining smooth patient access workflows. The position also entails conducting both onsite and virtual trainings and in-services to communicate regional payer policies, formulary updates, prior authorization criteria, coding and billing requirements, as well as distribution and reimbursement procedures.
The ideal candidate will independently manage a multistate territory, prioritizing accounts according to patient need, payer dynamics, and program demand. They will develop territory-specific engagement strategies tailored to local payer landscapes and practice resources, always adhering strictly to non-promotional and compliance guidelines to safeguard patient confidentiality and legal standards.
This role requires significant travel within the assigned territory—typically between 50 to 70 percent—ensuring thorough coverage and relationship building across key nephrology stakeholders. The Field Reimbursement Manager must exhibit strong communication, analytical, and strategic planning skills, with proficiency in CRM systems and various data tools to manage caseloads effectively.
Vertex offers a competitive salary range of $136,000 to $204,000, coupled with eligibility for annual bonuses and equity awards. Emphasizing a robust total rewards program, Vertex provides market-leading benefits tailored to support employees throughout their professional and personal lives, including medical, dental, and vision coverage, paid time off with seasonal shutdowns, educational assistance, commuter subsidies, matching charitable donations, and a 401(k) plan. This opportunity represents a chance to join a dynamic and mission-driven team at the forefront of kidney disease therapy development, where the work directly impacts the lives of patients nationwide.
Job Requirements
- Bachelor’s degree in health care, life sciences or business field
- Minimum 5+ years’ experience in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles
- Experience working with specialty biologics, rare disease therapies, or complex pharmacy benefit products
- Deep understanding of benefits investigations, prior authorization processes, appeals, coverage policies and payer ecosystems
- Payer knowledge and in-depth understanding of Medicare, Medicaid, and commercial insurance plans
- Ability to travel 50-70% within assigned territory
- Proficiency in Microsoft Outlook, Word, Excel, PowerPoint, Salesforce CRM
- Valid driver’s license and ability to meet safe driving requirements
- Ability to satisfy and meet all health care industry representative credentialing requirements to gain and maintain entry into facilities and organizations in assigned territory
Job Qualifications
- Experience working with specialty biologics, rare disease therapies, or complex pharmacy benefit products
- Account management experience working directly with HCPs and office staff to navigate complex access challenges
- Ability to navigate payer portals, CRM systems, and field access tools
- Strong communication, training, and relationship-building skills with provider office staff and internal PSP and vendor teams
- Strong analytical skills with ability to derive insights from customer and internal team engagements
- Ability to leverage data and reporting tools to manage caseload and prioritize patient needs
- Comfortable working in a fast-paced, results-driven environment within a growing business unit
- Experience developing and executing strategic business and account plans
- Demonstrated ability to facilitate appropriate judgment in decision making and problem solving
Job Duties
- Compliantly establish strong connections with key nephrology office personnel including care team and administrative staff responsible for prior authorizations and patient access to specialty medications
- Partner with case management team to address escalated access issues ensuring coordinated handoffs using CRM triggers and workflows
- Support timely patient access to prescribed Vertex medicines by educating offices on copay, PAP, Bridge programs and affordability pathways
- Provide timely follow-up on case status and ensure offices understand insurance documentation requirements
- Maintain comprehensive understanding of commercial and government prescription insurance coverage requirements for access and payer trends
- Conduct on-site and virtual in-services to deliver compliant and comprehensive education on regional payer policies, formulary updates, coverage nuances, PA/medical exception criteria, coding/billing (ICD-10, CPT), and documentation requirements
- Independently manage a multistate geographic region prioritizing accounts based on patient need, payer dynamics and KPSP demand
- Adapt engagement with prescribing HCP offices based on existing office workflows avoiding introducing complexities or inefficiencies
- Develop territory engagement plans reflecting local payer landscapes and practice resources to help minimize patient-specific access barriers
- Adhere to strict non-promotional guidelines ensuring all engagements comply with relevant legal, compliance and privacy regulations
- Maintain confidentiality of patient health information and act in compliance with all laws, regulations, and Vertex company policies
- Apply program business rules and work instructions to deliver a consistent and compliant patient and customer experience
Job Criteria
Experience
Mid Level (3-7 years)
Job Location
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