Reimbursement Specialist, CGT

McKesson•Cary, NC

2d•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 patients access innovative treatments by navigating insurance coverage and reimbursement processes and ensuring claims are accurately processed and reimbursed in a timely manner. It is hybrid, with 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, coordinates with providers, patients, market access, and insurers, and works with clinical case managers on authorization and claim appeals and denials. The role also maintains reimbursement documentation and reports, monitors relevant regulations, supports patients and families with coverage and financial-assistance information, and collaborates across teams to improve patient access. The working environment is an office environment.

Requirements

Typically requires 5 or more years of related experience.
5 or more years of experience in specialty pharmacy, rare disease, hospital billing, infusion billing, or another relevant service area, including benefit verification, prior authorizations, medical billing, or insurance reimbursement.
Experience in specialty healthcare or pharmaceuticals and 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 and collaboration skills, with the ability to influence others and build credible relationships across business units.
Ability to communicate effectively with patients, healthcare providers, and insurance companies, and 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 reimbursement issues.

Nice To Haves

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.
Familiarity with cell and gene therapies and the associated reimbursement landscape.
Experience specifically related to cell and gene therapies.

Responsibilities

Verify patients’ insurance coverage and benefits for cell and gene therapies, including pre-authorization requirements, limitations, and exclusions.
Coordinate with healthcare providers, patients, market access, and insurance companies to support accurate and timely reimbursement.
Work with clinical case managers to manage authorization and insurance claim appeals and denials, resolving issues with providers and insurers.
Maintain detailed records of reimbursement activities, statuses, reimbursement amounts, and issues, and generate reports as needed.
Stay current with insurance regulations and policies related to cell and gene therapies and ensure compliance with applicable guidelines.
Guide and support patients and families regarding insurance coverage, reimbursement options, and financial assistance programs.
Collaborate with healthcare providers, market access, billing, and patient advocacy groups to streamline reimbursement and improve patient access.