Reimbursement Specialist

Overview

McKesson is an impact-driven, Fortune 10 company that touches virtually every aspect of healthcare. We are known for delivering insights, products, and services that make quality care more accessible and affordable. Here, we focus on the health, happiness, and well-being of you and those we serve – we care.

What you do at McKesson matters. We foster a culture where you can grow, make an impact, and are empowered to bring new ideas. Together, we thrive as we shape the future of health for patients, our communities, and our people. If you want to be part of tomorrow’s health today, we want to hear from you.

At Biologics by McKesson, our mission is to simplify access to medication and deliver personalized care that helps patients achieve the best-possible outcomes — one patient, one partner, one therapy at time.

Job Description

Works in a fast paced, high-volume contact center environment to provide product specific reimbursement support to patients, healthcare providers, patient advocates, and manufacturer representatives. Will frequently interact via telephone with commercial payers to conduct insurance verifications and benefit investigations. Works daily with commercial payers to ensure appropriate coverage and reimbursement in a variety of therapeutic areas. Must have a solid working knowledge of insurance plans and benefit structures in order to obtain detailed benefit information and maximize plan benefits.

Obtains payer specific prior authorization procedures and documentation requirements, if applicable, and facilitates the prior authorization process for patients and healthcare providers. A general understanding of Medicare and Medicaid programs is desired. Position may require sales, project management and/or account coordination skills depending on the specific program.

Hybrid role in Cary, NC. Onsite requirement of 2 days a week.

The target budget for this role is between $23 and $24 an hour.

• Contact payers to verify patient eligibility and product specific coverage information.
• Interface with physicians, advocates, patients, and manufacturer representatives to obtain and provide drug specific coverage information.
• Provide prior authorization assistance as well as claims assistance, including billing and coding instructions, to physicians and/or office staff.
• Provide accurate and timely follow-up to all reimbursement inquiries in accordance with program guidelines.
• Ensure that the intake information is accurate and complete in order to perform all reimbursement research.
• Research and compile payer specific information for reimbursement database.
• Utilize internal resources to identify and provide alternate funding sources for patients without insurance or adequate coverage through their insurer.

Typically requires 3+ years of related experience.

HS Diploma or equivalent

• 2+ year s experience within a healthcare environment.
• Medical claims experience.
• Experience in the healthcare industry including, but not limited to, insurance verification and/or claim adjudication, physician’s office or outpatient billing, pharmacy and/or pharmaceutical manufacturers.
• Must be able to compose and document benefit investigation outcomes and prepare written status reports to management on a regular basis.

• ICD-10, HCPCS and CPT experience
• Ability to effectively handle multiple priorities within a changing environment
• Interpersonal skills
• Strong written and oral communication skills
• Strong organizational skills
• Proficient in MS Office
• Problem solving and decision-making skills

We are proud to offer a competitive compensation package at McKesson as part of our Total Rewards. This is determined by several factors, including performance, experience and skills, equity, regular job market evaluations, and geographical markets. The pay range shown below is aligned with McKesson's pay philosophy, and pay will always be compliant with any applicable regulations. In addition to base pay, other compensation, such as an annual bonus or long-term incentive opportunities may be offered.

For more information regarding benefits at McKesson, please .

Our Base Pay Range for this position: $17.47 - $29.11

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