Field Reimbursement Manager - Kidney (Tri-State - NY, PA, NJ)

General Summary: Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP), serving as a local subject matter expert to nephrology practices with non-promotional access and reimbursement education. Support timely patient access to prescribed Vertex kidney therapies through troubleshooting and territory-level payer expertise. Key Duties And Responsibilities: Build compliant relationships with nephrology office care team and administrative staff for prior authorizations and patient access. Partner with case management on escalated access issues; coordinate handoffs using CRM triggers/workflows. Educate offices on copay, PAP, Bridge programs, and affordability pathways. Follow up on case status and ensure offices understand insurance documentation requirements. Maintain understanding of commercial and government insurance coverage requirements and payer trends. Deliver compliant on-site/virtual in-services and training on payer policies/formulary updates, PA/medical exception criteria, ICD-10/CPT/coding and documentation, and distribution/hub/reimbursement workflows. Manage a multistate region; prioritize accounts based on patient need, payer dynamics, and KPSP demand. Develop territory engagement plans to minimize access barriers. Follow non-promotional guidelines and program business rules; maintain patient confidentiality and compliance. Knowledge And Skills: Experience with specialty biologics/rare disease therapies/complex pharmacy benefit products. Account management with HCPs/office staff; navigate payer portals, CRM systems, and field access tools. Strong communication/training/relationship-building, analytical, and data/reporting skills. Develop and execute strategic account plans; exercise sound judgment. Travel 50–70%; proficiency in Outlook/Word/Excel/PowerPoint/Salesforce CRM; valid driver’s license; meet credentialing requirements. Education And Experience: Bachelor’s degree (health care, life sciences, or business); advanced degree is a plus. 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access. Deep understanding of benefits investigations, PA/appeals/coverage policies, and payer ecosystems. In-depth knowledge of Medicare, Medicaid, and commercial plans. Pay Range: 136,000 - 204,000 Benefits: Eligible for annual bonus and annual equity awards. (Additional benefits listed.) Application Instructions: For application assistance: View email address on click.appcast.io #J-18808-Ljbffr