Field Reimbursement Manager - Kidney (OH-PA)

General Summary Field-based Field Reimbursement Manager for Vertex’s Kidney Patient Support Program (KPSP), serving as local subject matter expert to nephrology practices with non-promotional access and reimbursement education; troubleshooting to support timely patient access to prescribed kidney therapies. Key Duties and Responsibilities Build compliant relationships with nephrology office care and authorization/patient access personnel. Partner with case management to resolve escalated access issues; ensure coordinated handoffs using CRM triggers/workflows. Educate offices on copay, PAP, Bridge programs, and other affordability pathways to support timely access. Follow up on case status; ensure offices understand insurance documentation requirements. Maintain understanding of commercial/government insurance coverage requirements and payer trends. Conduct compliant on-site/virtual in‑services and training on payer policies, formulary updates, coverage nuances, PA/medical exceptions, ICD‑10/CPT, documentation, and reimbursement workflows/hub services/enrollment. Independently manage a multistate territory; prioritize accounts based on patient need, payer dynamics, and KPSP demand. Develop territory engagement plans to minimize access barriers; adhere to non-promotional guidelines, compliance/privacy guardrails, and patient confidentiality. Knowledge and Skills Specialty biologics/rare disease or complex pharmacy benefit experience; account management with HCP offices. Payer portal/CRM tool navigation; strong training/relationship-building, analytical/reporting skills. Strategic business/account plan experience; sound judgment. Travel 50–70%. Proficient: Outlook, Word, Excel, PowerPoint, Salesforce CRM. Valid driver’s license; meet credentialing requirements. Education and Experience Bachelor’s degree (health care/life sciences/business); advanced degree a plus. 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles. Deep understanding of benefits investigations, PA processes, appeals, coverage policies; Medicare/Medicaid/commercial knowledge. Pay Range $136,000–$204,000 (role may be eligible for annual bonus and equity). #J-18808-Ljbffr Scorpion Therapeutics