Reimbursement Specialist CGT

Biologics by McKesson Mission

At Biologics by McKesson, our mission is to simplify access to medication and deliver personalized care that helps patients achieve the best-possible outcomes - one patient, one partner, one therapy at time.

Position Summary

As a Cell and Gene Insurance Reimbursement Specialist, you will have the opportunity to make a significant impact on patients' access to life-changing therapies, while navigating the complexities of insurance reimbursement. If you are passionate about the intersection of healthcare and insurance and are driven to improve patient outcomes, we invite you to apply for this exciting role. We are seeking a highly skilled and motivated individual to join our team as a Cell and Gene Insurance Reimbursement Specialist. In this role, you will be responsible for supporting the reimbursement process for cell and gene therapies, ensuring that insurance claims are accurately processed and reimbursed in a timely manner. As a specialist in this emerging field, you will play a critical role in ensuring patients can access innovative treatments while navigating complex insurance coverage and reimbursement processes.

Key Responsibilities

• Insurance Verification: Verify patients' insurance coverage and benefits for cell and gene therapies, including pre-authorization requirements, limitations, and exclusions. Collaborate with healthcare providers, patients, market access, and insurance companies to ensure accurate and timely reimbursement for cell and gene therapies.

• Appeals and Denials: Work in conjunction with clinical case managers to manage appeals and denials related to authorizations and insurance claims for cell and gene therapies, working closely with healthcare providers and insurance companies to resolve issues.

• Documentation and Reporting: Maintain detailed records of insurance reimbursement activities, including status, reimbursement amounts, and any issues encountered during the process. Generate reports as needed.

• Compliance and Regulations: Stay up to date with evolving insurance regulations and policies related to cell and gene therapies, ensuring compliance with all relevant guidelines.

• Patient Support: Provide guidance and support to patients and their families regarding insurance coverage, reimbursement options, and financial assistance programs.

• Collaboration: Collaborate with cross-functional teams, including healthcare providers, market access, billing department, and patient advocacy groups, to streamline reimbursement processes and improve patient access to cell and gene therapies.

Minimum Requirement

Typically requires 5+ years of related experience.

Education

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 are preferred.

Critical Skills

• 5+ years' experience within 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 understanding of healthcare continuum and relationship between manufacturers, patients, providers, and payers

• Strong understanding of health insurance coverage and reimbursement processes, including knowledge of medical coding and billing practices. Familiarity with cell and gene therapies and the associated reimbursement landscape is a plus.

• Knowledge of applicable healthcare laws and regulations, including HIPAA, Medicare, and Medicaid guidelines.

Additional Skills

• Exceptional written and verbal communication skills, along with collaboration skills and ability to influence others; ability to build credible relationships across multi-business units.

• Ability to effectively communicate with patients, healthcare providers, 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 Specialized Knowledge and Skills

• Experience specifically related to cell and gene therapies is highly desirable.

• Strong prioritization, time management and project 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.

• Critical thinking, analytical, research, and problem-solving skills

Job Working Conditions:

Environment: Office environment

Physical Requirements: Office environment. 20% travel required