Field Reimbursement Manager - Kidney (Michigan-North Ohio)
Job Overview
Compensation
Salary
Range $136,000.00 - $204,000.00
Benefits
Medical insurance
Dental Insurance
Vision Insurance
Paid Time Off
401(k) retirement plan
educational assistance
Employee wellness programs
Job Description
Vertex Pharmaceuticals is a leading global biotechnology company dedicated to scientific innovation and improving the lives of patients with serious diseases. With a vibrant commitment to research and development, Vertex focuses on delivering transformative therapies, particularly in the area of rare and serious kidney diseases. As the company progresses towards the commercialization of new investigational therapeutics for conditions such as Immunoglobulin A nephropathy (IgAN), and other B cell-mediated and genetic kidney diseases, it has created a dynamic and supportive work environment aimed at patient-centric solutions. Vertex operates with an inclusive culture, offering equal employment opportunities and emphasizing diversity, equity, and inclusion in the workplace. Employees are supported through comprehensive benefits and programs that foster career growth, wellness, and financial security.
The Field Reimbursement Manager role at Vertex is a pivotal field-based position within the Kidney Patient Support Program (KPSP). This role is crafted to provide expert guidance and support to nephrology practices, ensuring patients receive timely access to Vertex’s specialized kidney therapies. The Field Reimbursement Manager acts as the local subject matter expert, focusing on non-promotional education around payer policies, reimbursement pathways, and patient assistance programs. This role demands a collaborative and strategic approach to build strong relationships with nephrology office personnel, care teams, and administrative staff responsible for prior authorizations and patient access. The successful candidate will work closely with cross-functional teams, including case management, leveraging CRM systems and payer intelligence to overcome payer barriers and streamline processes. This position requires an individual who excels in managing complex access challenges, navigating commercial and government insurance landscapes, and delivering compliant and effective education to healthcare providers. The Field Reimbursement Manager will independently manage a multistate territory, continuously developing territorial engagement plans and adapting interactions to suit office workflows. This role supports the patient journey by ensuring clarity and efficiency in handling insurance documentation, copay support, and coverage nuances while strictly adhering to all legal, compliance, and privacy standards. The salary range for this role is $136,000 to $204,000 annually, inclusive of eligibility for an annual bonus and equity awards, reflecting Vertex’s commitment to rewarding talent appropriately. Vertex provides a rich total rewards package including medical, dental, vision benefits, paid time off including seasonal company shutdowns, educational assistance, 401(k) plans, and more to support employees’ personal and professional wellbeing. This role is ideal for experienced professionals passionate about patient access and market access within the specialty biotech space, seeking to make a real impact in kidney disease treatment.
The Field Reimbursement Manager role at Vertex is a pivotal field-based position within the Kidney Patient Support Program (KPSP). This role is crafted to provide expert guidance and support to nephrology practices, ensuring patients receive timely access to Vertex’s specialized kidney therapies. The Field Reimbursement Manager acts as the local subject matter expert, focusing on non-promotional education around payer policies, reimbursement pathways, and patient assistance programs. This role demands a collaborative and strategic approach to build strong relationships with nephrology office personnel, care teams, and administrative staff responsible for prior authorizations and patient access. The successful candidate will work closely with cross-functional teams, including case management, leveraging CRM systems and payer intelligence to overcome payer barriers and streamline processes. This position requires an individual who excels in managing complex access challenges, navigating commercial and government insurance landscapes, and delivering compliant and effective education to healthcare providers. The Field Reimbursement Manager will independently manage a multistate territory, continuously developing territorial engagement plans and adapting interactions to suit office workflows. This role supports the patient journey by ensuring clarity and efficiency in handling insurance documentation, copay support, and coverage nuances while strictly adhering to all legal, compliance, and privacy standards. The salary range for this role is $136,000 to $204,000 annually, inclusive of eligibility for an annual bonus and equity awards, reflecting Vertex’s commitment to rewarding talent appropriately. Vertex provides a rich total rewards package including medical, dental, vision benefits, paid time off including seasonal company shutdowns, educational assistance, 401(k) plans, and more to support employees’ personal and professional wellbeing. This role is ideal for experienced professionals passionate about patient access and market access within the specialty biotech space, seeking to make a real impact in kidney disease treatment.
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
- Valid driver’s license and ability to meet safe driving requirements
- Ability to travel 50-70% within assigned territory
- 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 occasional holidays to meet organizational needs
- Ability to maintain confidentiality of patient health information and comply with all laws, regulations and company policies
- Strong communication and relationship-building skills
- Proficiency in Microsoft Outlook, Word, Excel, PowerPoint 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, prior authorization processes, appeals, coverage policies and payer ecosystems
- Payer knowledge and detailed 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 healthcare providers 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 teams
- Strong analytical skills to derive insights from customer and internal engagements
- Ability to leverage data and reporting tools to manage caseload and prioritize patient needs
- Experience developing and executing strategic business and account plans
- Demonstrated ability to facilitate judgment in decision making and problem solving
- Proficiency in Microsoft Outlook, Word, Excel, PowerPoint and Salesforce CRM
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 and ensure coordinated handoffs using CRM triggers and workflows
- Support timely patient access to prescribed Vertex medicine by educating offices on copay programs, patient assistance programs, 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 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
- 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 healthcare provider offices based on existing office workflows avoiding complexities or inefficiencies
- Develop territory engagement plans reflecting local payer landscapes and practice resources to minimize patient-specific access barriers
- Adhere to strict non-promotional guidelines ensuring all engagements comply with legal, compliance, and privacy standards
- Maintain confidentiality of patient health information and act in accordance with laws, regulations and Vertex 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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