Pharmacy AR Billing & Collection Specialist

McKesson•Cary, NC

3d•$20 - $33•Hybrid

About The Position

McKesson is an impact-driven, Fortune 10 company that touches virtually every aspect of healthcare. We are known for delivering insights, products, and services that make quality care more accessible and affordable. Here, we focus on the health, happiness, and well-being of you and those we serve – we care. What you do at McKesson matters. We foster a culture where you can grow, make an impact, and are empowered to bring new ideas. Together, we thrive as we shape the future of health for patients, our communities, and our people. If you want to be part of tomorrow’s health today, we want to hear from you. As a Pharmacy AR Billing and Collections Specialist, you will be at the heart of our financial operations, managing accounts receivable with precision and care. Your expertise will ensure that we maintain a healthy revenue cycle, minimize financial risks, and foster seamless collaboration with patients and partners.

Requirements

Typically requires 5+ years of related experience.
Prior experience managing a high volume of accounts receivable activities, including collections and follow-up, with attention to accuracy and timeliness in resolving reimbursement issues.
Strong understanding of health insurance coverage and reimbursement processes, including knowledge of NDC/HCPCS coding and billing practices.
Advanced knowledge of Medicare/Medicaid and commercial insurance billing and reimbursement policies/guidelines
Demonstrated experience performing detailed account research, analyzing EOBs and remittance advice and ability to effectively problem solve high dollar claims for quick resolution
Exceptional written and verbal communication skills, along with collaboration skills and ability to influence others; ability to build credible relationships across multi-business units.
Excellent verbal and written communication skills, with the ability to effectively communicate with third party payers and insurance companies.
Ability to work effectively in a team-oriented environment, collaborating with colleagues to achieve common goals.
Proficiency in Microsoft Office Suite, including Word, Excel, and PowerPoint
3+ years’ high volume collections experience within specialty pharmacy, medical/infusion office, or other relevant industry services.
Strong prioritization and time management skills
Ability to manage complex issues, function independently, demonstrate flexibility, as well as the ability to work effectively with remote internal and external teams.
Strong analytical and problem-solving skills, with the ability to identify and resolve issues related to insurance reimbursement.

Nice To Haves

Associate degree in healthcare administration, business, or a related field and/or relevant certifications or training in medical billing, insurance collections, payer policies, or reimbursement processes are preferred.
Familiarity with oncology therapies and the associated reimbursement landscape is a plus.
Experience specifically related to specialty pharmacy is highly desirable.

Responsibilities

AR Management: Oversee open accounts receivable daily to meet key revenue cycle performance indicators.
Strategic Collections: Analyze and address complex AR accounts outstanding over 31 days, employing effective collection strategies. Managing between 50-80 claims a day.
Account Adjustments: Process approved adjustments and promptly issue overpayment refunds.
Claims Expertise: Research and resolve denials, underpayments, and rejections; handle claims appeals efficiently.
Collaborative Resolution: Work with internal teams on account resolution and claims resubmission within timely filing guidelines.
Patient & Payer Communication: Respond to inquiries regarding claims and account status with clarity and professionalism.
Data Management: Maintain payer files, compile claims data, and produce comprehensive tracking and trending reports.
Regulatory Compliance: Stay updated on third-party payers and CMS reimbursement requirements, adhering to all guidelines and procedures.
Team Participation: Engage actively in billing and collection meetings, contributing to ongoing account resolutions.
Operational Excellence: Demonstrate a strong commitment to operational excellence and continuous improvement.
Additional Duties: Undertake other responsibilities as assigned by the supervisor and manager.