Payor Reimbursement Specialist

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

Benefits offered by this job

401k with match

Paid time off & holidays

Tuition reimbursement

Life insurance

Short & long-term disability

Job summary

Onco360 Pharmacy in Louisville, KY is seeking a Payor Reimbursement Specialist to handle day-to-day payor reimbursement processes and communications. Reporting to Reimbursement Manager, this role coordinates with Reimbursement leadership and Payer Sales to support end-to-end payer account maintenance.

The position requires experience in Pharmacy or Medical Billing, AR or Credential/Contracting, with a 3+ year healthcare/medical provider practice background.

Qualifications

• Previous experience in Pharmacy or Medical Billing, AR or Credential/Contracting is required.
• Bachelor’s degree in Business, Life Sciences, or related field is preferred.

Responsibilities

• Participates in payer launch activities ensuring collaboration between Reimbursement, Payer Sales, and Operations teams.
• Manage updates, reviews and contract document maintenance including Payor Contracting faxes, PBM Fax Blasts and emails.
• Communicate payor benefit programs and policies to Pharmacy personnel as needed.
• Inform managed clients about new medication access and handle inquiries.
• Analyze and report on company “No Go's” to evaluate contracting opportunities.
• Manage Operations payor escalations (AskOps).
• Initiate and execute LOAs for out-of-network providers as needed and manage LOAs.
• Assist with credentialing, Medicaid enrollment, and licensing needs as required by payer or internal team.
• Maintain positive professional attitude with Onco360/CareMed employees and clients.
• Perform other tasks as assigned.

Skills

Interpersonal skills

Time management

Decision making

Research

Education

Bachelor’s degree (Business/Life Sciences)

Experience in Pharmacy or Medical Billing

Job description

Location: Louisville, KY

Job Id:5709

# of Openings:1

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

Our Onco360 Corporate Office in Louisville, Kentucky has an immediate need for a Payor Reimbursement Specialist . Full Time, Monday to Friday from 9:00am to 5:30pm.

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.