Reimbursement Specialist, CGT

McKesson•Fort Worth, TX

2d•$20 - $33•Hybrid

About The Position

McKesson is seeking a Cell and Gene Insurance Reimbursement Specialist to support reimbursement for cell and gene therapies. The role helps ensure insurance claims are accurately processed and reimbursed in a timely manner, helping patients access innovative treatments while navigating complex coverage and reimbursement processes. The position is hybrid, requiring two days per week in the office at either the Cary, North Carolina, or Fort Worth, Texas location. The target budget is $26–$28 per hour; the posted base pay range is $19.87–$33.11 per hour. The specialist verifies insurance coverage and benefits, including prior-authorization requirements, limitations, and exclusions; works with clinical case managers on appeals and denials; maintains reimbursement records and reporting; stays current with relevant insurance regulations; and guides patients and families on coverage, reimbursement, and financial assistance. The role collaborates with healthcare providers, market access, billing, patient advocacy groups, insurers, and other cross-functional teams to streamline reimbursement and improve patient access. The role typically requires at least five years of related experience, particularly in specialty pharmacy, rare disease, hospital or infusion billing, benefit verification, prior authorizations, medical billing, or insurance reimbursement. An associate degree in healthcare administration, business, or a related field, and/or relevant certifications or training is preferred. Experience specifically related to cell and gene therapies is highly desirable.

Requirements

Typically requires 5+ years of related experience.
At least 5 years of experience in specialty pharmacy, rare disease, hospital billing, infusion billing, or other relevant industry services, including benefit verification, prior authorizations, medical billing, insurance reimbursement, or related services.
Experience in the specialty healthcare or pharmaceutical segment, with an understanding of the healthcare continuum and relationships among manufacturers, patients, providers, and payers.
Strong understanding of health insurance coverage and reimbursement processes, including medical coding and billing practices.
Knowledge of applicable healthcare laws and regulations, including HIPAA, Medicare, and Medicaid guidelines.
Exceptional written and verbal communication, collaboration, and influencing skills, with the ability to build credible relationships across multiple business units.
Ability to communicate effectively with patients, healthcare providers, and insurance companies.
Ability to work effectively in a team-oriented environment.
Proficiency in Microsoft Office Suite, including Word, Excel, and PowerPoint.
Strong prioritization, time-management, and project-management skills.
Ability to manage complex issues, work independently, demonstrate flexibility, and work effectively with remote internal and external teams.
Strong analytical, critical-thinking, research, and problem-solving skills, including the ability to identify and resolve insurance reimbursement issues.

Nice To Haves

Familiarity with cell and gene therapies and their reimbursement landscape.
Experience specifically related to cell and gene therapies is highly desirable.
An associate degree in healthcare administration, business, or a related field, and/or relevant certifications or training in medical billing and coding, health insurance, or reimbursement processes.

Responsibilities

Verify patients’ insurance coverage and benefits for cell and gene therapies, including prior-authorization requirements, limitations, and exclusions.
Collaborate with healthcare providers, patients, market access, and insurance companies to support accurate and timely reimbursement.
Work with clinical case managers to manage appeals and denials related to authorizations and insurance claims, coordinating with providers and insurers to resolve issues.
Maintain detailed records of reimbursement activities, including status, reimbursement amounts, and issues encountered; generate reports as needed.
Stay up to date with insurance regulations and policies related to cell and gene therapies and ensure compliance with relevant guidelines.
Guide and support patients and families regarding insurance coverage, reimbursement options, and financial assistance programs.
Collaborate with healthcare providers, market access, the billing department, and patient advocacy groups to streamline reimbursement and improve patient access.