McKesson Case Manager in Scottsdale, Arizona
McKesson is in the business of better health and we touch the lives of patients in virtually every aspect of healthcare. At McKesson Specialty Health, our products and services span the full continuum of specialty patient care. From the initial phases of a product life cycle and the distribution of specialty drugs, to fully integrated healthcare technology systems, practice management support, and ultimately to patient care in the communities where they live, we empower the community patient care delivery system by helping community practices advance the science, technology and quality of care.
We have a vision —that the long-term vibrancy of community care will be achieved through the leadership of physicians committed to clinical excellence and innovation, enabled by close collaboration with our organization and our deep clinical, operational and technological expertise.Every single McKesson employee contributes to our mission—by joining McKesson Specialty Health you act as a catalyst in a chain of events that helps millions of people all over the globe. You’ll collaborate on the products and solutions that help us carry out our mission to improve lives and advance healthcare. Working here is your opportunity to shape an industry that’s vital to us all.
Join our team of leaders to begin a rewarding career.
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.
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.
2 years' customer service experience
2 years' medical or insurance industry experience
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 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
Proficient in MS Office
ICD-10, HCPCS, CPT experience
HS Diploma or equivalent
Professional office environment
Benefits & Company Statement
McKesson believes superior performance – individual and team – that helps us drive innovations and solutions to promote better health should be recognized and rewarded. We provide a competitive compensation program to attract, retain and motivate a high-performance workforce, and it’s flexible enough to meet the different needs of our diverse employee population.
We are in the business of better health and we touch the lives of patients in virtually every aspect of healthcare. We partner with payers, hospitals, physician offices, pharmacies, pharmaceutical companies and others across the spectrum of care to build healthier organizations that deliver better care to patients in every setting.
But we can’t do it without you. 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. Talented, compassionate people are the future of our company—and of healthcare. At McKesson, you’ll collaborate on the products and solutions that help us carry out our mission to improve lives and advance healthcare. Working here is your opportunity to shape an industry that’s vital to us all.
McKesson is an equal opportunity and affirmative action employer – minorities/females/veterans/persons with disabilities.
Qualified applicants will not be disqualified from consideration for employment based upon criminal history.
No agencies please.
Job: Customer Care
Organization: McKesson Specialty Health
Title: Case Manager
Requisition ID: 18001981