Reimbursement Case Manager
Location: Scottsdale Arizona
Description: McKesson is at present looking to employ Reimbursement Case Manager right now, this occupation will be placed in Arizona. Further informations about this occupation opportunity kindly read the description below. Empowering patients starts with you. It starts with the chain of events you initiate when you work on the combined team of McKesson Specialty Health and US Oncology- a chain that ex! tends across the country uniting a network of community-based cancer clinics and resulting in millions of people getting more from their healthcare.
Across McKesson Specialty Health and US Oncology, our team affects the full continuum of healthcare - ultimately helping to improve the patient experience at the individual level. Our specialty pharmaceutical programs offer a significant impact for our customers and their businesses. The Distribution Services segment of our company is dedicated to the wholesale distribution of specialty pharmaceuticals - focusing on oncology and other specialty products. Our Specialty Patient Services group provides compliance and adherence programs, as well as reimbursement hotlines, patient assistance and support programs and the managed distribution of pharmaceutical products. Our Specialty Health is the largest single-site call center in healthcare, offering a centralized approach to optimize manufacturer product reimbursement and ! access. Our US Oncology operations unite one of the nation's l! argest health-care services network devoted exclusively to cancer treatment and research, and is a pioneer in community-based cancer care. Annually, the united network of more than 9,000 physicians, clinicians, nurses, and administrators delivers integrated cancer care to more than 850,000 cancer patients in community-based clinics located in 41 states.
Works in a fast paced, high-volume contact center environment with a variety of product support programs managing complex reimbursement issues. Works closely with healthcare providers and patients to assist with appeal management for claim denials. Works with physicians and payers to advocate for product specific coverage per payer specific P&T Committee protocol therefore, must possess the ability to communicate product benefits and efficacy and positively influence payer policy. Must have an in-depth understanding of insurance plans and benefit structures in order to obtain detailed benefit information and maximiz! e plan benefits. Obtains payer specific prior authorization procedures and documentation requirements if applicable and facilitate the prior authorization process for patients and healthcare providers. Needs to have an in-depth understanding of Medicare and Medicaid programs in order to effectively utilize internal resources and to conduct external research to identify alternate funding sources as appropriate. Position may require sales, project management and/or account coordination skills depending on the specific program.
Key Responsibilities:
1. Work with healthcare providers and patients to assist with appeal management for claim denials.
2. Work with physicians and payers to advocate for product specific coverage. Ability to communicate product benefits and efficacy to positively influence payer policy.
3. Capability to monitor drug coverage policies for multiple payers. Review case outcomes to analyze and identify payment and denial trends! as well as key findings for client reporting.
4. Conduct external ! research to identify appropriate alternate funding sources for inclusion to the internal resource database for future reference purposes.
5. Ability to effectively respond to escalated issues and complex cases referred from other Reimbursement employees or manufacturer representatives.
5 years of healthcare related reimbursement experience
Experience in the healthcare industry including, but not limited to, Medicare and/or Medicaid program administration, insurance verification and/or claim adjudication, physician’s office or outpatient billing, pharmacy and/or pharmaceutical manufacturers
Must be able to analyze reimbursement specific data and prepare written reports for management and client communications.
Excellent communication and organizational skills
Strong problem solving and decision making skills
Ability to effectively handle multiple priorities within a changing environment
Strong Interpersonal skills
Strong o! ral and written communication skills
Computer literacy
ICD-9, HCPCS, CPT experience
High School diploma or equivalent
General Office Demands
We believe you should be rewarded for the important work you do. For that reason, you'll receive a competitive compensation and benefits package when you join our team.
It starts with you. That's a simple sentence but it says a lot. It reminds each one of us that what we do matters. Every single McKesson employee contributes to our mission - whatever your title, whatever your role, you act as a catalyst in a chain of events that helps millions of people all over the globe. By connecting and improving the business of healthcare, we're helping to ensure that millions of patients get the treatment they need. And by choosing a career with McKesson Specialty Health, you'll join a team of passionate people working together to improve lives and advance healthcare.
At McKesson, we believe we! can empower healthcare. And it all starts with you.
As an equ! al opportunity employer, McKesson Corporation unites the talents and contributions of all to advance the power of healthcare. Learn more about our opportunities at mckesson.com/careers
No agencies please.
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If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to McKesson.
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This occupation starts available on: Sat, 27 Jul 2013 13:38:02 GMT