Reimbursement Specialist, CGT

McKesson; Fort Worth (TX); Híbrido; USD 36.000 - 39.000; Jornada completa

Descripción de la vacante

McKesson, a Fortune 10 healthcare leader, seeks a Cell and Gene Insurance Reimbursement Specialist who will help patients access life‑changing therapies. The hybrid role requires two in-office days weekly in Ft.

Worth, TX or Cary, NC, focusing on accurate claims processing and timely reimbursement. You will verify insurance, navigate denials, maintain records, and stay current with regulations while guiding patients through coverage and financial assistance options.

Formación

• 5+ years of experience in specialty pharmacy, rare disease, hospital billing, infusion billing, or related reimbursement services.
• Experience in healthcare or pharmaceutical segments with knowledge of payers and reimbursement.
• Knowledge of HIPAA, Medicare, and Medicaid guidelines.

Responsabilidades

• Verify patients' insurance coverage and benefits for cell and gene therapies, including pre-authorization requirements.
• Manage appeals and denials related to authorizations and claims with providers and payers.
• Maintain detailed records of reimbursement activities and generate reports as needed.
• Stay up to date with insurance regulations and ensure compliance with guidelines.
• Provide guidance to patients and families regarding coverage and financial assistance options.
• Collaborate with cross‑functional teams to streamline reimbursement processes.

Conocimientos

Insurance reimbursement

Cell & gene therapy

HIPAA compliance

Medical billing

Communication skills

Team collaboration

Problem solving

Educación

Associate degree in healthcare administration

Herramientas

Microsoft Office

Excel

Word

PowerPoint

Descripción del empleo

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

As a Cell and Gene Insurance Reimbursement Specialist, you will have the opportunity to make a significant impact on patients' access to life-changing therapies, while navigating the complexities of insurance reimbursement. If you are passionate about the intersection of healthcare and insurance and are driven to improve patient outcomes, we invite you to apply for this exciting role. We are seeking a highly skilled and motivated individual to join our team as a Cell and Gene Insurance Reimbursement Specialist. In this role, you will be responsible for supporting the reimbursement process for cell and gene therapies, ensuring that insurance claims are accurately processed and reimbursed in a timely manner. As a specialist in this emerging field, you will play a critical role in ensuring patients can access innovative treatments while navigating complex insurance coverage and reimbursement processes.

Location:

This role is hybrid and will require two days in office a week at either our Cary, NC or Ft. Worth, TX locations.

Compensation:

Target budget for this role is between $26 and $28 per hour.

Key Responsibilities

• Insurance Verification: Verify patients' insurance coverage and benefits for cell and gene therapies, including pre-authorization requirements, limitations, and exclusions. Collaborate with healthcare providers, patients, market access, and insurance companies to ensure accurate and timely reimbursement for cell and gene therapies.
• Appeals and Denials: Work in conjunction with clinical case managers to manage appeals and denials related to authorizations and insurance claims for cell and gene therapies, working closely with healthcare providers and insurance companies to resolve issues.
• Documentation and Reporting: Maintain detailed records of insurance reimbursement activities, including status, reimbursement amounts, and any issues encountered during the process. Generate reports as needed.
• Compliance and Regulations: Stay up to date with evolving insurance regulations and policies related to cell and gene therapies, ensuring compliance with all relevant guidelines.
• Patient Support: Provide guidance and support to patients and their families regarding insurance coverage, reimbursement options, and financial assistance programs.
• Collaboration: Collaborate with cross-functional teams, including healthcare providers, market access, billing department, and patient advocacy groups, to streamline reimbursement processes and improve patient access to cell and gene therapies.

Minimum Requirement

Typically requires 5+ years of related experience.

Education

Associate degree in healthcare administration, business, or a related field and/or relevant certifications or training in medical billing and coding, health insurance, or reimbursement processes are preferred.

Critical Skills

• 5+ years' experience within specialty pharmacy, rare disease, hospital billing, infusion billing, or other relevant industry services including benefit verification, prior authorizations, medical billing, insurance reimbursement, or related services.
• 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 applicable healthcare laws and regulations, including HIPAA, Medicare, and Medicaid guidelines.

Additional Skills

• Exceptional written and verbal communication skills, along with collaboration skills and ability to influence others; ability to build credible relationships across multi-business units.
• 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.
• 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

Job Working Conditions:

Environment: Office environment

Physical Requirements: Office environment.

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 click here.

Our Base Pay Range for this position

$19.87 - $33.11

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!