Payor Reimbursement Specialist

Onco360 • Woodridge, IL

3d • Remote

About The Position

Onco360 Pharmacy is seeking a remote, full-time Payor Reimbursement Specialist. The role tracks and manages day-to-day payor reimbursement processes, communications, escalations, and issues. Working closely with Reimbursement leadership and the Payer Sales team, the specialist serves as the reimbursement liaison for end-to-end payer account maintenance procedures. The position reports to the Reimbursement Manager and is scheduled Monday through Friday, 8:00 a.m. to 4:30 p.m. Compensation starts at $21.00 per hour.

Requirements

• Previous experience in pharmacy or medical billing, accounts receivable (AR), or credentialing/contracting.
• At least 3 years of experience in healthcare or a 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; persistent and persuasive.
• Strong work ethic and excellent time-management skills.
• Ability to work independently and collaboratively in a group setting.
• Detail-oriented, with 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, collaborating 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 at all 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 match
• Paid time off
• Paid holidays
• Tuition reimbursement
• Company-paid life insurance
• Company-paid short-term disability
• Company-paid long-term disability

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed