Payor Reimbursement Specialist
About The Position
Onco360 Pharmacy is hiring a remote, full-time Payor Reimbursement Specialist to track and manage payor reimbursement processes, communications, escalations, and issues. The role works closely with Reimbursement leadership and the Payer Sales team as the reimbursement liaison for end-to-end payer account maintenance. The position reports to the Reimbursement Manager and is scheduled Monday through Friday, 8:00 a.m. to 4:30 p.m. Onco360 is an oncology pharmacy serving community, oncology, and hematology physicians, patients, payers, and manufacturers. The organization describes its mission as improving the lives of people battling cancer and rare diseases, and emphasizes compassion, teamwork, respect, integrity, and passion, along with opportunities for professional and personal growth.
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 orientation and proficiency in prioritizing 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 and coordinate with Reimbursement, Payer Sales, and Operations teams.
- Manage updates, reviews, and contract document maintenance, including Payor Contracting faxes, PBM Fax Blasts, and emails received through contracting addresses across locations.
- Communicate payor 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 payor escalations (AskOps).
- Initiate and execute letters of agreement (LOAs) for out-of-network providers based on patient need, 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 insurance
- Dental insurance
- Vision insurance
- 401(k) with a company match
- Paid time off
- Paid holidays
- Tuition reimbursement
- Company-paid life insurance
- Company-paid short-term disability
- Company-paid long-term disability
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
