Payor Reimbursement Specialist

Onco360 Oncology Pharmacy; Houston (TX); On-site; USD 24,000 - 34,000; Full time

Benefits offered by this job

401k with match

Paid Time Off

Tuition Reimbursement

Company paid benefits – life insurance

Job summary

Onco360 is seeking a Payor Reimbursement Specialist to support payor reimbursement activities remotely from Houston, TX. The role reports to the Reimbursement Manager, with duties spanning end-to-end reimbursement processes and liaison work with Reimbursement leadership and Payer Sales teams.

Ideal candidates have 3+ years in healthcare or medical provider settings, experience in pharmacy or medical billing, and a Bachelor’s degree in Business or Life Sciences.

Qualifications

• 3+ years in healthcare or medical provider setting.
• Experience in pharmacy or medical billing.
• Bachelor’s degree in Business or Life Sciences preferred.

Responsibilities

• Track and manage payor reimbursement processes end-to-end.
• Coordinate with Reimbursement leadership and Payer Sales teams.
• Assist with credentialing, Medicaid enrollment, and licensing.
• Communicate payor programs and policies to pharmacy staff.
• Handle LOAs for out-of-network providers and manage escalations.

Skills

Interpersonal skills

Negotiation skills

Communication

Time management

Detail oriented

Education

Pharmacy or Medical Billing experience

Bachelor’s degree in Business/Life Sciences

Job description

Location: Houston, TX

Job Id:5711

# of Openings:1

Join our growing organization to make a difference in the lives of others! Payor Reimbursement Specialist needed!

Onco360 has an immediate need for a Payor Reimbursement Specialist . This position will work Remote. Full Time, Monday to Friday from 8:00am to 4:30pm.

Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.

A career with us is more than just a job. It's an opportunity to connect and care for our patients, providers, communities and each other. We attract extraordinary people who have a strong desire to live our mission - to better the lives of those battling cancer and rare diseases. Compassion is more important than numbers. We value teamwork, respect, integrity, and passion.

We succeed when you do, and our company and management team work hard to foster an environment that provides you with opportunities for both professional and personal growth.

Salary is from $21.00 per Hour and up

• 401k with a match
• Paid Time Off and Paid Holidays
• Tuition Reimbursement
• Company paid benefits - life insurance, short and long-term disability

The Payor Reimbursement Specialist, reporting to the Reimbursement Manager, is responsible for the day-to-day tracking and managing of payor reimbursement processes, communications, escalations, and issues. Working closely with both Reimbursement leadership and Payer Sales team, they will serve as the reimbursement liaison on end-to-end procedures for payer account maintenance.

• Participates in new Payer launch activities ensuring collaboration between Reimbursement, Payer Sales, and Operations teams.
• Manage all updates, reviews, and contract document maintenance including Payor Contracting faxes, PBM Fax Blasts and emails received via all locations’ Contracting addresses.
• Communicate to Pharmacy personnel payor benefit programs and policies as needed or directed by Reimbursement leadership.
• Communicate new medication access to all managed clients, as well as managing medication access inquiries.
• Analyze and report on company “No Go’s” to evaluate contracting opportunities.
• Manage all Operations payor escalations (AskOps).
• Initiating and executing letter of agreements (LOAs) for out of network providers based on patient need as well as manage active and expiring LOAs.
• Assist with credentialing, Medicaid enrollment, and licensing needs as required by payer or internal reimbursement team.
• Maintain a positive, professional attitude when dealing with Onco360/CareMed employees and clients.
• Perform other tasks as assigned.

Payor Reimbursement Specialist Qualifications

Education/Learning Experience

• Required: Previous Experience in Pharmacy or Medical Billing, AR or Credential/Contracting
• Desired: Bachelor’s degree in Business, Life Sciences, or other related field.

Work Experience

• Required: 3+ in Healthcare/ Medical provider practice
• Desired: 5+ in Specialty Pharmacy

Skills/Knowledge

• Required: Must have excellent interpersonal skills and be able to work with all levels of management and staff, both technical and non-technical. Strong, independent decision-making abilities are required. Must be able to conduct research, be resourceful, and self-reliant. Excellent communication skills including negotiation skills; must be persistent and persuasive.
• Required: Strong work ethic with excellent time management skills, excels at working independently but collaborative in a group setting as well. Detail oriented, proficient at prioritization of workload.