Vertex
Biotechnology
FieldReimbursementManager-Kidney
Neural analysis suggests this role is
optimal for Manager candidates.
“Field Reimbursement Manager - Kidney at Vertex. Skills: Reimbursement, Market access, Patient support, Payer knowledge. Establish connections with key nephrology office personnel. Support patient access to prescribed medications”
Industry & Context.
Troubleshooting; Problem solving; Decision making
Ability to travel 50-70%, Work on holidays on occasion
What They're Looking For.
Must Have
Minimum 5+ years’ experience in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles, Bachelor’s degree in health care, life sciences or business, Valid driver's license, Ability to meet safe driving requirements, Ability to satisfy and meet all health care industry representative credentialing requirements
Nice to Have
Advanced degree in business, healthcare, social services is a plus
What You'll Do.
Establish connections with key nephrology office personnel
Support patient access to prescribed medications
Partner with case management team
Address escalated access issues
Ensure coordinated handoffs
Support timely patient access to medicine
Educate offices on affordability pathways
Provide follow-up on case status
Ensure offices understand insurance documentation requirements
Maintain understanding of commercial and government prescription insurance
Maintain understanding of payer trends
Conduct on-site and virtual in-services
Deliver compliant education on regional payer policies
Deliver education on formulary updates
Deliver education on coverage nuances
Deliver education on PA/medical exception criteria
Deliver education on coding/billing
Deliver education on documentation requirements
Deliver education on distribution pathways
Deliver education on hub services
Deliver education on enrollment processes
Deliver education on reimbursement workflows
Conduct on-site and virtual training
Use approved payer guides
Use approved checklists
Use approved access tools
Use approved workflow maps
Independently manage a multistate geographic region
Prioritize accounts based on patient need
Prioritize accounts based on payer dynamics
Prioritize accounts based on KPSP demand
Adapt engagement with HCP offices
Develop territory engagement plans
Minimize patient-specific access barriers
Adhere to strict non-promotional guidelines
Maintain confidentiality of patient health information
Act in compliance with all laws
Apply program business rules
Apply work instructions
Deliver consistent and compliant patient experience
Deliver compliant customer experience
How You'll Work.
Team & Collaboration
Provider office staff; Internal PSP teams; Vendor teams; Case management team
Communication Scope
Training; Relationship-building
Full Job Description
**Job Description** **General Summary:** Vertex is currently building a field reimbursement team to support our upcoming journey to advance, develop, and deliver therapies to those living with serious kidney diseases. We are preparing for potential commercialization of investigational therapeutics being studied for the treatment of Immunoglobulin A nephropathy (IgAN), additional B cell-mediated diseases, and other genetic kidney diseases. We are seeking a dedicated and collaborative Field Reimbursement Manager to join our Kidney Patient Support Program (KPSP). In this field-based role, you will serve as the local subject matter expert to nephrology practices, providing non-promotional access and reimbursement education. You will also support timely access for patients to prescribed Vertex kidney therapies through effective troubleshooting and territory-level payer expertise. **Key Duties and Responsibilities:** * 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
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