Payor Reimbursement Specialist

The Payor Reimbursement Specialist, reporting to the Reimbursement Manager, is responsible for the day-to-day tracking and managing of payor reimbursement processes, communications, escalations, and issues. Working closely with both Reimbursement leadership and Payer Sales team, they will serve as the reimbursement liaison on end-to-end procedures for payer account maintenance.

Major Responsibilities

• Participates in new Payer launch activities ensuring collaboration between Reimbursement, Payer Sales, and Operations teams.
• Manage all updates, reviews, and contract document maintenance including Payor Contracting faxes, PBM Fax Blasts and emails received via all locations' Contracting addresses.
• Communicate to Pharmacy personnel payor benefit programs and policies as needed or directed by Reimbursement leadership.
• Communicate new medication access to all managed clients, as well as managing medication access inquiries.
• Analyze and report on company "No Go's" to evaluate contracting opportunities.
• Manage all Operations payor escalations (AskOps).
• Initiating and executing letter of agreements (LOAs) for out of network providers based on patient need as well as manage active and expiring LOAs.
• Assist with credentialing, Medicaid enrollment, and licensing needs as required by payer or internal reimbursement team.
• Maintain a positive, professional attitude when dealing with Onco360/CareMed employees and clients.
• Perform other tasks as assigned.

Qualifications

Required: Previous Experience in Pharmacy or Medical Billing, AR or Credential/Contracting. Desired: Bachelor's degree in Business, Life Sciences, or other related field.

Work Experience Required: 3+ in Healthcare/Medical provider practice. Desired: 5+ in Specialty Pharmacy.

Skills/Knowledge Required: Must have excellent interpersonal skills and be able to work with all levels of management and staff, both technical and non-technical. Strong, independent decision-making abilities are required. Must be able to conduct research, be resourceful, and self-reliant. Excellent communication skills including negotiation skills; must be persistent and persuasive.

Behavior Competencies Required: Strong work ethic with excellent time management skills, excels at working independently but collaborative in a group setting as well. Detail oriented, proficient at prioritization of workload.