Payor Reimbursement Specialist

Onco360•Louisville, KY

1d•$23•Onsite

About The Position

Onco360 Pharmacy is seeking a Payor Reimbursement Specialist for its corporate office in Louisville, Kentucky. The position manages day-to-day tracking and administration of payor reimbursement processes, communications, escalations, and issues. Working with Reimbursement leadership and the Payer Sales team, the specialist serves as the reimbursement liaison for end-to-end payer account maintenance procedures. The role participates in payer launches, maintains payer and contract documentation, communicates payer benefit programs and medication access information, handles inquiries and operational escalations, and supports out-of-network agreements and payer-related credentialing, enrollment, and licensing needs. The position reports to the Reimbursement Manager. This is a full-time position, Monday through Friday, from 9:00 a.m. to 5:30 p.m. The starting pay is $23.00 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 skills, including 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, coordinating among 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 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.