The Woodlands, TX
McKesson Corporation is a Fortune 8 company and is one of the largest providers of healthcare supply chain management solutions, retail pharmacy, medical & pharmaceutical supplies, healthcare technology, community oncology and specialty care in the United States with revenues of $231 billion in 2020. The company was founded in 1833 by John McKesson and Charles Olcott in New York with a focus on importing and wholesaling pharmaceutical products. United by our ICARE shared principles, McKesson's 80,000 employees work together every day to make better care possible around the globe – one product, one partner, one patient at a time.
Reimbursement Specialist is responsible for the timely and accurate identification of insurance payments and/or denials on outstanding accounts receivable either via phone and/or electronic contact with the payer. Qualified candidates must have excellent written and verbal communication skills, computer literacy, and the ability to multi-task in a fast-paced work environment. Under the direction of the Reimbursement Manager, candidates will be responsible for meeting specified quantity and quality goals for follow up on accounts.
ESSENTIAL FUNCTIONS AND DUTIES
Promotes a positive work environment and contributes to a dynamic team focused work unit that actively helps one another to achieve optimal department and organizational results.
Strikes a balance between maintaining trustful relationships and ensuring timely payments. Exhibits professionalism and trustworthiness.
Reviews accounts, takes appropriate action, and documents per departmental standards. Ensures the reason for the denial (clinical, administrative, or technical) is clearly stated on the payment documentation. Handles technical issues and forwards clinical and administrative issues to the appropriate group for review.
Confers with Billers, as necessary, to obtain additional information/clarification and requests rebills as needed. Confers with Intake, as necessary to obtain retro auth and/or benefits verification as needed.
Researches denials and determines if there is a legitimate case for overturning the denial, in accordance with the payor’s medical policy or the contract. Drafts and submits appeals using a sound argument for denials that have a reasonable chance of being overturned.
Informs manager of payor trends or any problems or changes in payor requirements, including any barriers or obstacles.
Provides clear and concise documentation of every action taken on an account in the system collection notes. Provides balance breakdown to document the status of next responsible party (i.e., primary, secondary payor, patient balance, or credit balance).
Identifies accounts for advanced due diligence steps or legal placement in accordance with department policy and procedure. Effectively manages inventory in accordance with departmental standards.
Utilizes contracting modeling and notifies manager if incorrect payments/contractual are being calculated.
Meets or exceeds stated Performance Indicator Expectations (e.g., productivity, account reviews, agings) as demonstrated on weekly Key Performance Indicator.
Follows up on assigned delinquent insurance claims. Ensures maximization of collection dollars from insurance companies in accordance with the respective contract.
Analyzes accounts for errors, adjustments and credits, issuing corrected entries when necessary. Updates account information accordingly. Follows levels of authority for posting adjustments, refunds, and contractual allowances.
Uses resources effectively and efficiently. Organizes time effectively, minimizing incidental overtime, and sets priorities. Utilizes time between heavy workloads efficiently and helps other team members.
Stays current on various payors and industry trends. Seeks opportunities to expand learning beyond baseline competencies with a focus on continual development.
Generates and communicates new ideas and suggestions that will improve quality or service. Demonstrates adaptability and flexibility in the face of changing demands.
3+ years of experience in healthcare industry; preferably in insurance follow up and/or collections.
- 3 year knowledge of insurance benefits which includes, deductibles, co-insurance, out-of-pocket, plan exclusions and prior authorization requirements preferred
- Must be able to communicate effectively, both orally and in writing.
- Must demonstrate ability to work well in a team dynamic as well as independently.
- Must demonstrate adaptability to handle changing priorities in a high volume, fast-paced work environment.
- Must demonstrate exceptional organizational skills and ensure attention to detail at all times.
- Excellent personal computing skills and a working knowledge of MS Office software
- Additional Knowledge & Skills
- Accounting experience, reading, writing and arithmetic skills. Some knowledge of credit and/ or collection policies, practices and systems, as well as familiarity with spreadsheet applications.
Must be authorized to work in the US. Sponsorship is not available for this position.
We take pride in our culture of connection and believe in a workplace where everyone can be their full, authentic self. We welcome and encourage veterans, individuals with disabilities and others with diverse perspectives to join our growing team. Your unique perspective and experience are valuable assets that can translate into a rewarding career path with us. Apply to join our team and help shape the future of healthcare!
Career Level – IC – Business Support – B3
At McKesson, we care about the well-being of the patients and communities we serve, and that starts with caring for our people. That’s why we have a Total Rewards package that includes comprehensive benefits to support physical, mental, and financial well-being. Our Total Rewards offerings serve the different needs of our diverse employee population and ensure they are the healthiest versions of themselves. For more information regarding benefits at McKesson, please click here.
As part of Total Rewards, we are proud to offer a competitive compensation package at McKesson. This is determined by several factors, including performance, experience and skills, equity, regular job market evaluations, and geographical markets. In addition to base pay, other compensation, such as an annual bonus or long-term incentive opportunities may be offered.
Our Base Pay Range for this position$19.16 - $31.94
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 the internal career site.
Join us at McKesson!