Payor Reimbursement Specialist
About The Position
Onco360 Pharmacy is seeking a remote Payor Reimbursement Specialist to track and manage day-to-day payor reimbursement processes, communications, escalations, and issues. Reporting to the Reimbursement Manager, the specialist works closely with Reimbursement leadership and the Payer Sales team as the reimbursement liaison for end-to-end payer account maintenance. The role supports new payer launches, maintains payer contract documents and updates, communicates payer benefit programs and medication access information, and manages operational escalations and letters of agreement. The specialist also assists with credentialing, Medicaid enrollment, and licensing needs. This is a full-time position with a Monday-to-Friday schedule of 9:00 a.m. to 5:30 p.m.
Requirements
- Previous experience in pharmacy or medical billing, accounts receivable, or credentialing/contracting.
- At least 3 years of experience in a healthcare or medical provider practice.
- Excellent interpersonal skills and ability to work with all levels of management and staff, both technical and non-technical.
- Strong independent decision-making abilities.
- Ability to conduct research and be resourceful and self-reliant.
- Excellent communication and negotiation skills; persistence and persuasiveness.
- Strong work ethic and excellent time-management skills.
- Ability to work independently and collaboratively in a group setting.
- Detail-oriented with the ability to prioritize workload.
Nice To Haves
- Bachelor’s degree in Business, Life Sciences, or another related field.
- At least 5 years of experience in specialty pharmacy.
Responsibilities
- Participate in new payer launch activities, collaborating with Reimbursement, Payer Sales, and Operations teams.
- Manage updates, reviews, and maintenance of contract documents, including Payor Contracting faxes, PBM fax blasts, and emails received through locations’ contracting addresses.
- Communicate payer benefit programs and policies to Pharmacy personnel as needed or directed by Reimbursement leadership.
- Communicate new medication access to managed clients and manage medication access inquiries.
- Analyze and report on company “No Go’s” to evaluate contracting opportunities.
- Manage Operations payer escalations (AskOps).
- Initiate and execute letters of agreement (LOAs) for out-of-network providers based on patient needs, and manage active and expiring LOAs.
- Assist with credentialing, Medicaid enrollment, and licensing needs as required by payers or the internal reimbursement team.
- Maintain a positive, professional attitude when dealing with Onco360/CareMed employees and clients.
- Perform other tasks as assigned.
Benefits
- Medical, dental, and vision benefits.
- 401(k) with a company match.
- Paid time off and paid holidays.
- Tuition reimbursement.
- Company-paid life insurance and short- and long-term disability benefits.
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
