Reimbursement Specialist

RXinsider LTD.; Cary (NC); Hybrid; USD 29,000 - 30,000; Full time

Job summary

McKesson is seeking a reimbursement specialist to support patients, providers, and advocates in a fast-paced, hybrid role based near Cary, NC. You will verify coverage, assist with prior authorization, and interface with physicians and payers to maximize benefits.

The role requires 3+ years in healthcare reimbursement, strong documentation skills, and proficiency with MS Office. The position offers a base pay with bonus opportunities and a two-day-in-office expectation weekly.

Qualifications

• 3+ years of related experience in healthcare reimbursement.
• Experience with insurance verification and/or claim adjudication.
• Ability to document benefit investigations and prepare status reports.

Responsibilities

• Verify patient eligibility and coverage with payers.
• Interface with physicians, advocates, patients, and manufacturers to obtain coverage details.
• Provide prior authorization and claims assistance, including coding instructions.
• Provide timely follow-up per program guidelines.
• Ensure intake information is accurate for reimbursement research.
• Research payer-specific information for reimbursement databases.
• Identify alternate funding sources for patients without insurance.

Skills

Insurance verification

Claims adjudication

Healthcare claims

Physician office experience

MS Office

Education

HS Diploma or equivalent

Job description

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.

Role Overview

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.

Location

This role is hybrid and will require two days in office a week at the Cary, NC location.

Compensation

The target salary for this role is between $21 and $22 an hour along with a 5% bonus.

Key Responsibilities

• 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 inquires 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.

Minimum Requirement

Typically requires 3+ years of related experience.

Education

HS Diploma or equivalent

Critical Skills

• 2+ years 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.

Additional Knowledge & Skills

• 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

Physical Requirements

Professional office environment – this position requires the availability between 8 AM to 8 PM ET.

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.

Our Base Pay Range for this position

$17.99 - $29.98

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. For additional information on McKesson’s full Equal Employment Opportunity policies, visit our Equal Employment Opportunity page.

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]. Resumes or CVs submitted to this email box will not be accepted.

Join us at McKesson!