Field Reimbursement Manager - Kidney (IN-KY-TN)

Clarksville, TN, USA|

Job Overview

Compensation

Salary

Range $136,000.00 - $204,000.00

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Paid Time Off

401(k)

educational assistance

Commuter Benefits

Job Description

Vertex is a global biotechnology company dedicated to scientific innovation, specializing in developing transformative therapies for serious diseases. With a focus on improving patient outcomes, Vertex is expanding its efforts in the nephrology field by creating a dedicated field reimbursement team to support the commercialization of investigational therapeutics. These therapies target serious kidney conditions, including Immunoglobulin A nephropathy (IgAN), B cell-mediated diseases, and other genetic kidney disorders. The company emphasizes fostering patient access to advanced treatments through cutting-edge scientific research and comprehensive support programs. Vertex is committed to equal employment opportunities and embraces diversity, ensuring a supportive work environment for all employees. The company offers competitive compensation, inclusive benefits, and opportunities for career growth within a fast-paced and innovative biotechnology sector.

The role of Field Reimbursement Manager is a critical position within Vertex's Kidney Patient Support Program (KPSP). This field-based role requires a dedicated professional who will serve as a local subject matter expert in nephrology practices, focusing on providing non-promotional access and reimbursement education. The manager will play a vital role in facilitating timely patient access to Vertex's kidney therapies by supporting healthcare providers and administrative staff. This includes educating on copay, patient assistance programs (PAP), bridge programs, and other affordability pathways to ensure patients receive prescribed medications promptly. The role demands collaboration with case management teams to handle escalated access issues and requires territory-level expertise in payer systems.

Furthermore, the Field Reimbursement Manager will maintain a comprehensive understanding of commercial and government insurance coverage policies, payer trends, and reimbursement workflows. The position involves conducting both on-site and virtual training sessions to provide compliant and thorough education on regional payer policies, prior authorization criteria, coding and billing practices, distribution pathways, and enrollment processes. Managing a multistate geographic region independently requires strategic planning to prioritize accounts based on patient needs, payer dynamics, and program demand while adhering to strict non-promotional and legal compliance guidelines. The role offers a dynamic work environment that encourages strategic thinking, problem-solving, relationship-building, and contributing to the successful access and reimbursement of specialty kidney therapies, making a meaningful impact on patient care and the advancement of innovative treatments.

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
ability to travel 50-70% within assigned territory
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
ability to work occasionally on holidays to meet organizational needs
strong communication skills
proficiency in Microsoft Office and Salesforce CRM

Job Qualifications

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
deep understanding of benefits investigations, PA processes, appeals, coverage policies, and payer ecosystems
payer knowledge and in-depth understanding of Medicare, Medicaid, and commercial insurance plans
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
proficiency in Microsoft Outlook, Word, Excel, PowerPoint, Salesforce CRM

Job Duties

Compliantly establish strong connections with key nephrology office personnel including members of the 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 and ensure coordinated handoffs using CRM triggers and workflows
support timely patient access to their prescribed Vertex medicine by educating offices on copay, PAP, Bridge programs, and other affordability pathways
provide timely follow-up on case status and ensure offices understand insurance documentation requirements
maintain a 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, and coverage nuances
PA/medical exception criteria, coding/billing (ICD-10, CPT), and documentation requirements
distribution pathways, hub services, enrollment processes, and reimbursement workflows
conduct on-site and virtual training using approved payer guides, checklists, access tools, and workflow maps
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 and avoid 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 guardrails
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