Reimbursement & Medical Benefits Operations Supervisor

BLG Biologics, Inc.; Cary (NC); Ibrido; USD 71.000 - 73.000; Tempo pieno

Descrizione del lavoro

McKesson, a Fortune 10 healthcare leader, seeks a Supervisor for CGT Reimbursement & Medical Benefit Operations. You will lead a team supporting cell and gene therapy reimbursement, medical benefit investigations, and provider billing, while coaching staff and driving performance.

The role is hybrid, located near Cary, NC or Ft. Worth, TX, with a target annual compensation of $71,000–$73,000 plus a 5% bonus.

Competenze

• 3+ years of specialty pharmacy, medical benefit reimbursement, provider billing, revenue cycle, or hospital reimbursement experience.
• People leadership or supervisory experience.
• Demonstrated medical benefit and billing experience required.
• Experience in the specialty healthcare or pharmaceutical sector with understanding of healthcare continuum and relationships among manufacturers, patients, providers, and payers.
• Strong understanding of health insurance coverage and reimbursement processes, including knowledge of medical coding and billing practices.
• Familiarity with cell and gene therapies and the associated reimbursement landscape is a plus.
• Knowledge of payer policy interpretation, coding, claims adjudication, and reimbursement methodologies.
• Strong analytical, communication, and cross-functional collaboration skills.
• Knowledge of healthcare laws and regulations, including HIPAA, Medicare, and Medicaid guidelines.
• Excellent written and verbal communication skills with the ability to influence and build relationships across multi-business units.
• Excellent verbal and written communication skills with patients, providers, and insurers.

Mansioni

• Lead, coach, mentor, and develop a team of reimbursement and medical benefit specialists.
• Conduct performance reviews, succession planning, employee development, and workforce planning.
• Oversee medical benefit investigations, prior authorizations, reimbursement support, and complex payer escalations.
• Partner with internal medical billing teams to ensure claims are billed accurately and compliantly.
• Consult with Contracting teams regarding LOAs and SCAs to support reimbursement and operational requirements.
• Support Accounts Receivable teams with denial management, underpayments, payer disputes, and reimbursement resolution.
• Serve as reimbursement SME for Cell and Gene Therapy and broader Biologics medical benefit programs.
• Lead process improvement initiatives and launch readiness activities for new therapies.

Conoscenze

People leadership

Communication skills

Analytical skills

Cross-functional collaboration

Formazione

Bachelor degree in healthcare, business, finance, nursing, or related discipline

Strumenti

Microsoft Office Suite (Word, Excel, PowerPoint)

Descrizione del lavoro

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.

Biologics by McKesson Mission

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.

Role Overview

The Supervisor, CGT Reimbursement & Medical Benefit Operations is responsible for leading a team supporting Cell and Gene Therapy reimbursement, medical benefit investigations, provider billing support, and broader Biologics medical benefit operations. This role serves as a reimbursement verification and medical billing subject matter expert while providing direct supervision, coaching, performance management, and development of reimbursement professionals.

Location

This is a hybrid role and candidates must live within a drivable distance of our Ft. Worth, TX or Cary, NC locations.

Compensation

The target compensation for this role is between $71,000 and $73,000 annually along with a 5% bonus.

Key Responsibilities

• Lead, coach, mentor, and develop a team of reimbursement and medical benefit specialists.
• Conduct performance reviews, succession planning, employee development, and workforce planning.
• Oversee medical benefit investigations, prior authorizations, reimbursement support, and complex payer escalations.
• Partner with internal medical billing teams to ensure claims are billed accurately and compliantly.
• Consult with Contracting teams regarding LOAs and SCAs to support reimbursement and operational requirements.
• Support Accounts Receivable teams with denial management, underpayments, payer disputes, and reimbursement resolution.
• Serve as reimbursement SME for Cell and Gene Therapy and broader Biologics medical benefit programs.
• Lead process improvement initiatives and launch readiness activities for new therapies.

Minimum Requirement

Typically requires 3+ years of subject matter experience including exhibiting leadership capabilities.

Education

Bachelor degree preferred in healthcare, business, finance, nursing, or related discipline.

Critical Skills

• 3+ years of specialty pharmacy, medical benefit reimbursement, provider billing, revenue cycle, or hospital reimbursement experience.
• People leadership or supervisory experience.
• Demonstrated medical benefit and billing experience required.
• Experience in the specialty healthcare or pharmaceutical segment with understanding of healthcare continuum and relationship between manufacturers, patients, providers, and payers.
• Strong understanding of health insurance coverage and reimbursement processes, including knowledge of medical coding and billing practices.
• Familiarity with cell and gene therapies and the associated reimbursement landscape is a plus.
• Knowledge of payer policy interpretation, coding, claims adjudication, and reimbursement methodologies.
• Strong analytical, communication, and cross-functional collaboration skills.
• Knowledge of applicable healthcare laws and regulations, including HIPAA, Medicare, and Medicaid guidelines.
• Exceptional written and verbal communication skills, along with collaboration skills and ability to influence others; ability to build credible relationships across multi-business units.
• Excellent verbal and written communication skills, with the ability to effectively communicate with patients, healthcare providers, and insurance companies.
• Ability to work effectively in a team-oriented environment, collaborating with colleagues to achieve common goals.
• Proficiency in Microsoft Office Suite, including Word, Excel, and PowerPoint.

Specialized Knowledge and Skills

• Experience specifically related to cell and gene therapies is highly desirable.
• Strong prioritization, time management and project management skills.
• Ability to manage complex issues, function independently, demonstrate flexibility, as well as the ability to work effectively with remote internal and external teams.
• Knowledge of LOAs, SCAs, payer/provider contracting implications, and treatment site reimbursement.
• Experience supporting A/R, denial prevention, and reimbursement optimization.
• Strong analytical and problem-solving skills, with the ability to identify and resolve issues related to insurance reimbursement.
• Critical thinking, analytical, research, and problem-solving skills.

Working Conditions

Environment: Office environment.

Physical Requirements Office environment 20% travel required.

Compensation Details

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.

Base Pay Range

Our Base Pay Range for this position $59,200 - $98,600

Equal Opportunity Employment

McKesson is an Equal Opportunity Employer. McKesson provides equal employment opportunities to applicants and employees, without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, age, genetic information, or any other legally protected category.

McKesson is committed to being an Equal Employment Opportunity Employer and offers opportunities to all job seekers including job seekers with disabilities. If you need a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to (United States) [e-mail] or (Canada) [e-mail].

Join us at McKesson! 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.