Remote Claims Resolution Specialist Jobs in Raleigh, NC

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The Supervisor, CGT Reimbursement & Medical Benefit Operations is responsible for leading a team supporting Cell and Gene Therapy reimbursement, medical benefit investigations, provider billing support, and broader Biologics medical benefit operations. This role serves as a reimbursement and medical billing subject matter expert while providing direct supervision, coaching, performance management, and development of reimbursement professionals.

Location: This is a hybrid role and candidates must live within a drivable distance of our Ft. Worth, TX or Cary, NC locations.

Compensation: The target compensation for this role is between $71,000 and $73,000 annually along with a 5% bonus.

Key Responsibilities

• Lead, coach, mentor, and develop a team of reimbursement and medical benefit specialists.

• Conduct performance reviews, succession planning, employee development, and workforce planning.

• Oversee medical benefit investigations, prior authorizations, reimbursement support, and complex payer escalations.

• Partner with internal medical billing teams to ensure claims are billed accurately and compliantly.

• Consult with Contracting teams regarding LOAs and SCAs to support reimbursement and operational requirements.

• Support Accounts Receivable teams with denial management, underpayments, payer disputes, and reimbursement resolution.

• Serve as reimbursement SME for Cell and Gene Therapy and broader Biologics medical benefit programs.

• Lead process improvement initiatives and launch readiness activities for new therapies.

Minimum Requirement

Typically requires 3+ years of subject matter experience including exhibiting leadership capabilities.

Education
Bachelor degree preferred in healthcare, business, finance, nursing, or related discipline.

Critical Skills

• 3+ years of specialty pharmacy, medical benefit reimbursement, provider billing, revenue cycle, or hospital reimbursement experience.

• 2+ years of leadership or supervisory experience.

• Demonstrated medical benefit and billing experience required.

• Experience in the specialty healthcare or pharmaceutical segment with understanding of healthcare continuum and relationship between manufacturers, patients, providers, and payers

• Strong understanding of health insurance coverage and reimbursement processes, including knowledge of medical coding and billing practices. Familiarity with cell and gene therapies and the associated reimbursement landscape is a plus.

• Knowledge of payer policy interpretation, coding, claims adjudication, and reimbursement methodologies.

• Strong analytical, communication, and cross-functional collaboration skills.

• Knowledge of applicable healthcare laws and regulations, including HIPAA, Medicare, and Medicaid guidelines.

• Exceptional written and verbal communication skills, along with collaboration skills and ability to influence others; ability to build credible relationships across multi-business units.

• Excellent verbal and written communication skills, with the ability to effectively communicate with patients, healthcare providers, and insurance companies.

• Ability to work effectively in a team-oriented environment, collaborating with colleagues to achieve common goals.

• Proficiency in Microsoft Office Suite, including Word, Excel, and PowerPoint

Additional Skills

• Experience specifically related to cell and gene therapies is highly desirable.

• Strong prioritization, time management and project management skills

• Ability to manage complex issues, function independently, demonstrate flexibility, as well as the ability to work effectively with remote internal and external teams.

• Knowledge of LOAs, SCAs, payer/provider contracting implications, and treatment site reimbursement.

• Experience supporting A/R, denial prevention, and reimbursement optimization.

• Strong analytical and problem-solving skills, with the ability to identify and resolve issues related to insurance reimbursement.

• Critical thinking, analytical, research, and problem-solving skills

Working Conditions
Environment: Office environment

Physical Requirements

Office environment. 20% travel required.

We are proud to offer a competitive compensation package at McKesson as part of our Total Rewards. This is determined by several factors, including performance, experience and skills, equity, regular job market evaluations, and geographical markets. The pay range shown below is aligned with McKesson's pay philosophy, and pay will always be compliant with any applicable regulations. In addition to base pay, other compensation, such as an annual bonus or long-term incentive opportunities may be offered. For more information regarding benefits at McKesson, pleaseclick here.

Our Base Pay Range for this position

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