Health Services Specialist at McKesson in Cary, North Carolina

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.


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.


This position works in a fast paced, high-volume contact center environment to provide product specific reimbursement support to patients, healthcare providers, 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.


The Case Manager is responsible for working closely with healthcare providers, patients and drug manufacturer's programs managing complex reimbursement issues. Must have an in-depth understanding 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 facilitate the prior authorization process for patients and healthcare providers. Needs to have an in-depth understanding of Medicare and Medicaid programs in order to effectively utilize internal resources and to conduct external research to identify alternate funding sources as appropriate.



Essential Duties and Responsibilities



• Work with healthcare providers and patients to assist with appeal management for claim denials.
• Work with physicians and payers to advocate for product specific coverage. Ability to communicate product benefits and efficacy to positively influence payer policy.
• Capability to monitor drug coverage policies for multiple payers. Review case outcomes to analyze and identify payment and denial trends as well as key findings for client reporting.
• Ability to effectively respond to escalated issues and complex cases referred from other Reimbursement employees or manufacturer representatives.
• Conduct external research to identify appropriate alternate funding sources for inclusion to the internal resource database for future reference purposes.



Minimum Requirement

• Typically requires 3+ years of related experience.
  
  

Additional Skills



• Experience in the healthcare industry including, but not limited to, Medicare and/or Medicaid program administration, insurance verification and/or claim adjudication, physician's office or outpatient billing, pharmacy and/or pharmaceutical manufacturers.
• Must be able to analyze reimbursement specific data and prepare written reports for management and client communications.
• Customer service experience and medical or insurance industry experience.
• Excellent communication and organizational skills.
• Strong problem solving and decision-making skills and ability to effectively handle multiple priorities.


Career Level - IC Business Support - B3


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. 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



$16.89 - $28.15



McKesson is an Equal Opportunity Employer



McKesson provides equal employment opportunities to applicants and employees and is committed to a diverse and inclusive environment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, age or genetic information. For additional information on McKesson's full Equal Employment Opportunity policies, visit our Equal Employment Opportunity page.



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