Field Reimbursement Manager - Kidney (Northern California - San Francisco, San Jose, Sacramento)
Job Overview
Compensation
Salary
Range $136,000.00 - $204,000.00
Benefits
Medical insurance
Dental Insurance
Vision Insurance
Paid Time Off
educational assistance
Commuting subsidy
401(k) Plan
Matching charitable donations
Job Description
Vertex is a leading global biotechnology company dedicated to scientific innovation in the pursuit of groundbreaking therapies and treatments. With a strong commitment to improving the lives of patients worldwide, Vertex specializes in developing transformative medicines in areas of high unmet medical need. One of the company’s central focuses is serious kidney diseases, where it aims to advance, develop, and deliver novel therapeutics to patients who require specialized care and support. Known for its inclusive work culture and commitment to diversity, Vertex fosters an environment where innovation and collaboration thrive, enabling the company to make significant strides in biotechnology and patient care. The company offers a competitive employment package, including an annual bonus, equity awards, and comprehensive benefits that support the financial, health, and personal growth of its employees.
The role of Field Reimbursement Manager at Vertex is a vital position within the Kidney Patient Support Program (KPSP). This field-based role targets support and reimbursement activities related to kidney therapies, particularly those aimed at treating immunoglobulin A nephropathy (IgAN), B cell-mediated diseases, and other genetic kidney conditions. The Field Reimbursement Manager will act as a local expert in nephrology practices, focusing on non-promotional education regarding access and reimbursement for prescribed kidney therapies. Key responsibilities include establishing and maintaining strong relationships with nephrology office personnel, navigating complex payer ecosystems, and facilitating timely patient access to Vertex medications through troubleshooting and educational efforts.
The Field Reimbursement Manager serves as the crucial bridge between patients, healthcare providers, and payers. This includes partnering closely with case management teams to address and escalate access issues, providing education on copay assistance, patient assistance programs (PAP), bridge programs, and other affordability solutions. The role demands a thorough understanding of commercial and government insurance prescription coverage policies, payer trends, and documentation requirements. The manager will conduct both onsite and virtual training sessions, educate staff on regional payer policy nuances and coding requirements, and ensure all activities comply with strict non-promotional and legal guidelines.
Successful candidates for this position will typically have a bachelor’s degree in healthcare, life sciences, or business, with preference given to those holding advanced degrees in related fields. A minimum of five years of experience working in sales, reimbursement, market access, specialty pharmacy, or patient services is required, along with deep knowledge of insurance benefits investigations, prior authorization processes, appeals, and payer systems. Additional skills such as proficiency in CRM systems like Salesforce, Microsoft Office applications, strong analytical capabilities, strategic account planning, and the ability to travel 50-70% are essential for success in this role.
Vertex offers a competitive salary range from $136,000 to $204,000, alongside a broad array of market-leading benefits including medical, dental, and vision coverage, paid time off, educational assistance, commuting subsidies, 401(k) plans, and charitable donation matching. The company culture emphasizes compliance, confidentiality, and respect for patient privacy, ensuring that all operations align with legal and ethical standards. This is an exciting opportunity for professionals passionate about making a measurable impact in kidney disease therapy access and patient support within a dynamic and pioneering biotech organization.
The role of Field Reimbursement Manager at Vertex is a vital position within the Kidney Patient Support Program (KPSP). This field-based role targets support and reimbursement activities related to kidney therapies, particularly those aimed at treating immunoglobulin A nephropathy (IgAN), B cell-mediated diseases, and other genetic kidney conditions. The Field Reimbursement Manager will act as a local expert in nephrology practices, focusing on non-promotional education regarding access and reimbursement for prescribed kidney therapies. Key responsibilities include establishing and maintaining strong relationships with nephrology office personnel, navigating complex payer ecosystems, and facilitating timely patient access to Vertex medications through troubleshooting and educational efforts.
The Field Reimbursement Manager serves as the crucial bridge between patients, healthcare providers, and payers. This includes partnering closely with case management teams to address and escalate access issues, providing education on copay assistance, patient assistance programs (PAP), bridge programs, and other affordability solutions. The role demands a thorough understanding of commercial and government insurance prescription coverage policies, payer trends, and documentation requirements. The manager will conduct both onsite and virtual training sessions, educate staff on regional payer policy nuances and coding requirements, and ensure all activities comply with strict non-promotional and legal guidelines.
Successful candidates for this position will typically have a bachelor’s degree in healthcare, life sciences, or business, with preference given to those holding advanced degrees in related fields. A minimum of five years of experience working in sales, reimbursement, market access, specialty pharmacy, or patient services is required, along with deep knowledge of insurance benefits investigations, prior authorization processes, appeals, and payer systems. Additional skills such as proficiency in CRM systems like Salesforce, Microsoft Office applications, strong analytical capabilities, strategic account planning, and the ability to travel 50-70% are essential for success in this role.
Vertex offers a competitive salary range from $136,000 to $204,000, alongside a broad array of market-leading benefits including medical, dental, and vision coverage, paid time off, educational assistance, commuting subsidies, 401(k) plans, and charitable donation matching. The company culture emphasizes compliance, confidentiality, and respect for patient privacy, ensuring that all operations align with legal and ethical standards. This is an exciting opportunity for professionals passionate about making a measurable impact in kidney disease therapy access and patient support within a dynamic and pioneering biotech organization.
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
- 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
- Valid driver’s license and ability to meet safe driving requirements
- Ability to satisfy and meet all healthcare industry representative credentialing requirements to gain and maintain entry into facilities and organizations in assigned territory
- Proficiency in Microsoft Outlook, Word, Excel, PowerPoint, Salesforce CRM
- While the company is usually closed on holidays, employees may be asked on occasion to work 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 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/account plans
- Demonstrated ability to facilitate appropriate judgment in decision making and problem solving
- Ability to travel 50-70% within assigned territory
- 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 to support patient access to prescribed medications
- Partner with case management team to address escalated access issues
- 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
- all engagements must be compliant with relevant legal/compliance/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
Job Criteria
Experience
Mid Level (3-7 years)
Job Location
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