Case Manager

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 maximize 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

• Work with healthcare providers and patients to assist with appeal management for claim denials.
• Work with physicians and payers to advocate for product-specific coverage. Ability to communicate product benefits and efficacy to positively influence payer policy.
• 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.
• Conduct external research to identify appropriate alternate funding sources for inclusion to the internal resource database for future reference purposes.
• Ability to effectively respond to escalated issues and complex cases referred from other Reimbursement employees or manufacturer representatives.

Minimum Requirements

• 2+ years’ customer service experience
• 2+ years’ medical or insurance industry experience

Critical Skills

• 5 years’ 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.

Additional Knowledge & Skills

• 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 oral and written communication skills
• Proficiency in MS Office
• ICD-10, HCPCS, CPT experience

Education

• HS Diploma or equivalent

Physical Requirements

• Professional office environment – this position requires availability between 6:00 am – 6:00 pm Arizona time

CAREER LEVEL: B3

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 Disability_Accommodation@McKesson.com. Resumes or CVs submitted to this email box will not be accepted.Current employees must apply through internal career site.Join us at McKesson!