Join our team of leaders to begin a rewarding career as a Full-Time Health Services Associate!
To drive paid therapy outcomes for patients, providers, pharmaceutical company representatives and healthcare service companies for specialty prescription drugs with reimbursement and billing challenges.
This position is located at 1951 Bishop Lane, Louisville, KY
Conduct full medical and pharmacy Benefit Investigations
Make outbound calls to Insurance Payers, Specialty Pharmacies to obtain patient’s benefits
Assists offices with billing issues and claims/appeals
Provide consultative services where issues arise on how obstacles can be overcome in order to get patient on paid therapy.
Communicate with internal partners to ensure case coordination. Level of communication must be superior to service key accounts
Designates cases where missing information from the prescriber is an obstacle in moving the case forward to paid therapy and provides this information to the prescribers and Sales Representatives.
Maintains all patient confidentiality
When applicable, Report Adverse Events (AE) and Report on Product Quality Complaints
Other duties and responsibilities as assigned by supervisor based on the specific client contract.
Minimum (Required) Qualifications:
The Case Manger III Benefit Investigator will be in regular contact with payers, specialty pharmacies, pharmacy benefit managers, and teammates.
High School Diploma or Equivalent
Three to Five years experience in reimbursement case management, preferable in the insurance and/or pharmaceutical/biotechnology industry
Working knowledge of reimbursement (i.e. benefit investigation, prior authorization, pre-certification, letters of medical necessity
Knowledge of Medical Terminology preferred
Working knowledge of drug reimbursement issues
Knowledge of HCPCS, CPT and ICD-9 coding
Ability to negotiate favorable outcomes with payor and prescribers in obtaining needed information and decisions
Ability to express ideas clearly in both written and oral communications
Strong attention to detail and ability to multi-task
Strong computer skills required; preferably Microsoft Word or Excel software applications
Data entry skills required
Ability to resolve problems independently
Ability to calculate figures and amounts such as discounts and percentages; necessary to provide correct benefit and co-pay information
Ability to follow instructions
Adaptable to changing priorities as needed
Have exceptional attention to detail and excellent analytical, investigation, and problem solving skills
Ability to manage multiple priorities concurrently
Responsible for case management for top key accounts
Detailed weekly conference calls with ISS
Detailed weekly spreadsheets on all cases (Pending and Approved) to ISS
Detailed weekly spreadsheets to key accounts
Verify that medication is ready to ship
Verify that it is in place for teach or injection
Communicate with MDO and ISS on issues
Responsible for meeting quality and turn-around-time objectives
Strong customer service skills; including ability to convey compassion for patients
May sit seven to ten hours per day
May be necessary to work extended hours as needed
Finger dexterity to operate office equipment required
May need to lift up to twenty-five pounds on occasion
Visual acuity to see and read fine prints
Must be able to hear normal voice sounds
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this role
Work in a climate-controlled, smoke-free internal environment
These job responsibilities are executed as part of a customer service call center
The position will be located in a fast-paced organization with the potential for a variety of unplanned activities to occur simultaneously
McKesson is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, creed, sex, sexual orientation, gender identity, national origin, disability, or protected Veteran status.Qualified applicants will not be disqualified from consideration for employment based upon criminal history.McKesson is committed to being an Equal Employment Opportunity Employer and offers opportunities to all job seekers including job seekers with disabilities. If you need a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to [email protected] Resumes or CVs submitted to this email box will not be accepted.Current employees must apply through internal career site.Join us at McKesson!