Payor Reimbursement Specialist

Onco360 • Buffalo, NY

3d • Remote

About The Position

Onco360 Pharmacy is a specialized oncology pharmacy serving community, oncology, and hematology physicians, patients, payers, and manufacturers. The Payor Reimbursement Specialist works remotely, full time, Monday through Friday from 9:00 a.m. to 5:30 p.m., and reports to the Reimbursement Manager. The role 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 a reimbursement liaison for end-to-end payer account maintenance procedures.

The role supports new payer launches, maintains payer and contract documentation, communicates payor benefit information and medication access updates, handles operational escalations, and coordinates letters of agreement for out-of-network providers. It also assists with credentialing, Medicaid enrollment, and licensing as needed. The listed starting pay is $21.00 per hour.

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.
• Attention to detail 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 collaborate 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.
• Communicate payor benefit programs and policies to pharmacy personnel as needed or as directed by Reimbursement leadership.
• Communicate new medication access information 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, dental, and vision coverage.
• 401(k) with a match.
• Paid time off and paid holidays.
• Tuition reimbursement.
• Company-paid life insurance and short- and long-term disability.

What This Job Offers

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