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About the role
Key responsibilities & impact- 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
- Manage appeals and denials related to authorizations and insurance claims with clinical case managers, healthcare providers, and insurance companies
- Maintain detailed records of insurance reimbursement activities, status, reimbursement amounts, and issues
- Generate reports as needed
- Stay current with evolving insurance regulations and policies related to cell and gene therapies
- Ensure compliance with relevant guidelines
- Provide guidance and support to patients and families regarding insurance coverage, reimbursement options, and financial assistance programs
- Collaborate with healthcare providers, market access, billing, and patient advocacy groups to streamline reimbursement processes and improve patient access to cell and gene therapies
Requirements
What you’ll need- Typically requires 5+ years of related experience
- 5+ years’ experience within specialty pharmacy, rare disease, hospital billing, infusion billing, or other relevant industry services
- Experience including benefit verification, prior authorizations, medical billing, insurance reimbursement, or related services
- Experience in the specialty healthcare or pharmaceutical segment
- Understanding of the healthcare continuum and relationships between manufacturers, patients, providers, and payers
- Strong understanding of health insurance coverage and reimbursement processes
- Knowledge of medical coding and billing practices
- Knowledge of applicable healthcare laws and regulations, including HIPAA, Medicare, and Medicaid guidelines
- Proficiency in Microsoft Office Suite, including Word, Excel, and PowerPoint
- Exceptional written and verbal communication and collaboration skills
- Ability to communicate with patients, healthcare providers, and insurance companies
- Ability to work effectively in a team-oriented environment
- Strong prioritization, time management, and project management skills
- Ability to manage complex issues and function independently
- Ability to work effectively with remote internal and external teams
- Strong analytical and problem-solving skills
- Critical thinking, analytical, research, and problem-solving skills
- 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
- Experience specifically related to cell and gene therapies is highly desirable
Benefits
Comp & perks- Competitive compensation package
- Annual bonus or long-term incentive opportunities may be offered
- Benefits through McKesson’s Total Rewards program
- Equal employment opportunities
- Reasonable accommodation for applicants with disabilities