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; provide non-promotional access and reimbursement education; support timely patient access through troubleshooting and payer expertise. Key Duties And Responsibilities Establish connections with nephrology office care team and administrative staff (prior authorizations/patient access) to support access to prescribed medications. Partner with case management to address escalated access issues; use CRM triggers/workflows for coordinated handoffs. Educate offices on copay, PAP, Bridge programs, and affordability pathways. Provide timely follow-up on case status and ensure understanding of insurance documentation requirements. Maintain understanding of commercial and government prescription insurance coverage requirements, access/payer trends. Conduct on-site/virtual in-services and training (compliant education) covering: Regional payer policies, formulary updates, coverage nuances. PA/medical exception criteria, ICD-10/CPT coding, documentation. Distribution pathways, hub services, enrollment, reimbursement workflows. Manage a multistate territory independently; prioritize accounts based on patient need, payer dynamics, and KPSP demand. Develop territory engagement plans to minimize patient access barriers; align with office workflows. Follow strict non-promotional guidelines and legal/compliance/privacy requirements. Maintain patient health information confidentiality; apply program business rules for consistent compliant experience. Knowledge And Skills Specialty biologics/rare disease therapies/complex pharmacy benefit experience. Account management with HCP/office staff; navigate payer portals/CRM/field tools. Communication/training/relationship-building; analytical and data/reporting skills for caseload prioritization. Strategic business/account planning; judgment/problem-solving. Travel 50–70%; proficiency with Microsoft Office and Salesforce CRM; valid driver’s license and ability to meet credentialing. Education And Experience Bachelor’s degree in healthcare/life sciences/business (advanced degree preferred). Minimum 5+ years in sales, reimbursement, market access, specialty pharmacy, patient services, or field-based access roles. Deep understanding of benefits investigations, PA, appeals, coverage policies, payer ecosystems. Knowledge of Medicare, Medicaid, and commercial plans. Benefits Eligible for annual bonus and annual equity awards; annual base pay range: $136,000–$204,000. #J-18808-Ljbffr