Payor Reimbursement Specialist
About The Position
Onco360 Pharmacy is seeking a remote, full-time 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 procedures. The position is scheduled Monday through Friday, 9:00 a.m. to 5:30 p.m., and pays from $21.00 per hour. Onco360 Pharmacy 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.
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 among Reimbursement, Payer Sales, and Operations teams.
- Manage updates, reviews, and contract document maintenance, including payer contracting faxes, PBM fax blasts, and emails received through contracting addresses at all locations.
- 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 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 working 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- and long-term disability
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
