Field Reimbursement Manager - Kidney (North Carolina-Virginia)
Job Overview
Compensation
Salary
Range $136,000.00 - $204,000.00
Benefits
Health Insurance
Dental Insurance
Vision Insurance
Paid Time Off
educational assistance
Retirement Plan
Commuting subsidy
Job Description
Vertex is a leading global biotechnology company that invests in scientific innovation to develop transformative therapies for people living with serious diseases. With a strong focus on advancing, developing, and delivering cutting-edge treatments, Vertex specializes in addressing complex health conditions, including cystic fibrosis and other serious illnesses. The company is known for maintaining a collaborative and inclusive work environment, offering competitive compensation, and comprehensive benefits to its employees. Vertex is committed to equal employment opportunity and fosters diversity in its workforce. It is an E-Verify Employer in the United States and provides reasonable accommodations for qualified individuals with disabilities. The work environment is designed to keep employees engaged and supported throughout their career growth and personal well-being journey.
Currently, Vertex is building a dedicated field reimbursement team that will play a key role in supporting the company’s upcoming efforts to commercialize novel therapies for serious kidney diseases. This initiative focuses on investigational therapeutics for conditions such as Immunoglobulin A nephropathy (IgAN), additional B cell-mediated diseases, and other genetic kidney diseases, reflecting Vertex’s commitment to addressing unmet medical needs in nephrology. The Kidney Patient Support Program (KPSP) is central to this effort, offering comprehensive assistance to patients to help them access the life-changing treatments they need.
The Field Reimbursement Manager role is a field-based position serving as a critical local expert resource within nephrology practices. This individual will focus on providing non-promotional education and support concerning access and reimbursement for Vertex’s kidney therapies. With a goal to facilitate timely and efficient access for patients, the Field Reimbursement Manager will navigate complex payer systems, collaborate with healthcare providers' offices, and troubleshoot challenges related to treatment accessibility. The successful candidate will independently manage a multistate territory, prioritize accounts based on patient needs and payer dynamics, and develop territory engagement plans tailored to local payer landscapes. Strong knowledge of commercial and government insurance programs including Medicare, Medicaid, and commercial plans is essential to the role.
This position requires a professional with proven experience in specialty biologics, rare disease therapies, or complex pharmacy benefit products, along with strong communication and relationship-building skills. The ideal candidate will be adept at navigating payer portals, CRM systems, and field access tools, ensuring compliance with legal and organizational guidelines while maintaining patient confidentiality. The role demands a strategic thinker capable of executing business and account plans, as well as handling escalated access cases in partnership with case management teams. This job involves considerable travel (50-70%) within the assigned territory, emphasizing flexibility and resilience in a fast-paced environment.
Vertex offers a competitive base salary range between $136,000 and $204,000 for this position, along with eligibility for annual bonuses and equity awards. Additional benefits include comprehensive health insurance, paid time off, educational assistance programs, and a generous commuting subsidy. Employees enjoy a balanced work-life rhythm supported by company-wide shutdowns during Summer and Winter seasons. By joining Vertex, the successful candidate becomes part of an innovative company dedicated to transforming the lives of patients through breakthrough science and compassionate support programs.
Currently, Vertex is building a dedicated field reimbursement team that will play a key role in supporting the company’s upcoming efforts to commercialize novel therapies for serious kidney diseases. This initiative focuses on investigational therapeutics for conditions such as Immunoglobulin A nephropathy (IgAN), additional B cell-mediated diseases, and other genetic kidney diseases, reflecting Vertex’s commitment to addressing unmet medical needs in nephrology. The Kidney Patient Support Program (KPSP) is central to this effort, offering comprehensive assistance to patients to help them access the life-changing treatments they need.
The Field Reimbursement Manager role is a field-based position serving as a critical local expert resource within nephrology practices. This individual will focus on providing non-promotional education and support concerning access and reimbursement for Vertex’s kidney therapies. With a goal to facilitate timely and efficient access for patients, the Field Reimbursement Manager will navigate complex payer systems, collaborate with healthcare providers' offices, and troubleshoot challenges related to treatment accessibility. The successful candidate will independently manage a multistate territory, prioritize accounts based on patient needs and payer dynamics, and develop territory engagement plans tailored to local payer landscapes. Strong knowledge of commercial and government insurance programs including Medicare, Medicaid, and commercial plans is essential to the role.
This position requires a professional with proven experience in specialty biologics, rare disease therapies, or complex pharmacy benefit products, along with strong communication and relationship-building skills. The ideal candidate will be adept at navigating payer portals, CRM systems, and field access tools, ensuring compliance with legal and organizational guidelines while maintaining patient confidentiality. The role demands a strategic thinker capable of executing business and account plans, as well as handling escalated access cases in partnership with case management teams. This job involves considerable travel (50-70%) within the assigned territory, emphasizing flexibility and resilience in a fast-paced environment.
Vertex offers a competitive base salary range between $136,000 and $204,000 for this position, along with eligibility for annual bonuses and equity awards. Additional benefits include comprehensive health insurance, paid time off, educational assistance programs, and a generous commuting subsidy. Employees enjoy a balanced work-life rhythm supported by company-wide shutdowns during Summer and Winter seasons. By joining Vertex, the successful candidate becomes part of an innovative company dedicated to transforming the lives of patients through breakthrough science and compassionate support programs.
Job Requirements
- Bachelor’s degree in healthcare, 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
- Strong communication skills
- Proficiency in Microsoft Outlook, Word, Excel, PowerPoint, Salesforce CRM
- Ability to work in a fast-paced, results-driven environment
- Ability to maintain confidentiality of patient health information and comply with all laws and company policies
- Willingness to occasionally work on holidays to meet organizational needs
Job Qualifications
- Bachelor’s degree in healthcare, life sciences or business field
- Advanced degree in business, healthcare, social services is a plus
- 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 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 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 patient support program and vendor teams
- Strong analytical skills to derive insights from customer and internal team 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 appropriate judgment in decision making and problem solving
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 to support patient access to prescribed 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
- Independently manage a multistate geographic region prioritizing accounts based on patient need, payer dynamics, and KPSP demand
Job Criteria
Experience
Mid Level (3-7 years)
Job Location
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