Vertex

Biotechnology

FieldReimbursementManager-Kidney(NorthCentral-IA,MO,IL)

$136–204k United States FULL TIME Remote Friendly
Market Sentiment
HIGH DEMAND

Neural analysis suggests this role is
optimal for Manager candidates.

The Brief

“Field Reimbursement Manager - Kidney (North Central - IA, MO, IL) at Vertex. Skills: Reimbursement education, Patient access, Payer knowledge. Establish connections with key nephrology office personnel. Support patient access to prescribed medications”

Industry & Context.

Biotechnology
Problems you'll solve

Problem solving; Troubleshooting

Eligibility Requirements

Travel 50-70%, Valid driver's license, Meet safe driving requirements, Meet credentialing requirements

What They're Looking For.

Must Have

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, Meet safe driving requirements, Meet healthcare industry representative credentialing requirements

Nice to Have

Advanced degree in business, healthcare, social services

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 Vertex medicine

Educate offices on affordability pathways

Provide follow-up on case status

Ensure offices understand insurance documentation requirements

Maintain understanding of prescription insurance coverage requirements

Maintain understanding of payer trends

Conduct on-site and virtual in-services

Deliver compliant education on regional payer policies

Deliver compliant education on formulary updates

Deliver compliant education on coverage nuances

Deliver compliant education on PA/medical exception criteria

Deliver compliant education on coding/billing

Deliver compliant education on documentation requirements

Deliver compliant education on distribution pathways

Deliver compliant education on hub services

Deliver compliant education on enrollment processes

Deliver compliant 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

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 non-promotional guidelines

Maintain confidentiality of patient health information

Act in compliance with laws and policies

Apply program business rules

Apply work instructions

Deliver consistent patient experience

Deliver compliant customer experience

How You'll Work.

Team & Collaboration

Provider office staff; PSP teams; Vendor teams

Communication Scope

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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