McKesson Manager, Pharmacy Reimbursement Services (McKesson Specialty Health) in The Woodlands, Texas

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.

Current Need

Manager, Pharmacy Reimbursement Services

Position Description

McKesson Specialty Health empowers the community patient care delivery system to advance the science, technology and quality of care. Our vision — that the long term vibrancy of community care will be achieved through the leadership of clinics committed to clinical excellence and innovation — is supported by a broad set of proven, customizable offerings including distribution and GPO services, integrated productivity enhancing technologies, revenue cycle and payer solutions, clinical tools and business resources. We work with practices to improve purchasing efficiency, enhance productivity, and support patient care.

We offer Solutions for Oncology, which provide oncology practices with the choice, flexibility and ability to engage with us through a variety of innovative clinical, technology and business capabilities. We empower vibrant and sustainable independent community-based oncology practices through a broad set of proven, customizable services including distribution and GPO services, unparalleled integrated technology, revenue cycle and payer solutions, clinical tools, business resources and clinical trial support.

The Pharmacy Reimbursement Services Manager (PRSM) is responsible for managing and supporting Pharmacy Reimbursement by providing assistance with reimbursement challenges (including provider network credentialing, claims audit, pharmacy audits, accreditation, and policy and procedures) and educating the office on Payer payer requirements and current contract requirements through both remote interaction and on-site support when applicable. This position is payer-facing and practice-facing and requires the ability to build relationships with physician offices as well as payer representatives who manage audit and network management. The PRSM works independently in a fast paced, highly visible environment as well as collaboratively with the internal pharmacy/dispensary account management team. PRSM will frequently interact via telephone with providers and internal team to arrange meetings, data gathering, and trainings. Must have a solid working knowledge of the drug benefit payer industry, Medicare, Medicaid, insurance plans and benefit structures in order to relay detailed information and maximize the customer experience. Position will require limited travel, project management and/or account coordination. They will be an extension of the Sr. Director of Managed Care Pharmacy Services and Strategy on matters related to network development, credentialing, audits, and associated efforts needed to position the medically integrated pharmacy care services provider in a positively evaluated and regarded status.

The Pharmacy Reimbursement Services Manager will report to the Senior Director of Managed Care Pharmacy Services and Strategy and will also work closely with Healthmart Atlas, MSH’s managed care, US Oncology and Open market team to ensure that the reimbursement support services are communicated and leveraged in our relationships with our practices.

Key Responsibilities:

Provide timely education, support and guidance for the dispensary/pharmacy staff and internal account teams in regard to reimbursement support services that are available. Interaction will include:

Reimbursement Support:

  • Payer requirements (policy and procedures, protocols, etc)

  • Claims audit best practices (avoidance, successful navigation)

  • Credentialing and Accreditation activities

  • Claims / Appeal assistance

Reporting:

  • Track and report on audit activity. Identify key areas of focus, initiate and manage efforts to leverage audit activity into best practices and audit avoidance efforts.

  • Track and report on credentialing activity. Maintain and revise as needed credentialing guide and supporting information, templates or guidance.

  • Track and report accreditation activity. Identify in place accreditation that is in place currently, provide review and assessment ongoing of various accreditation options. Work with Senior Director of Managed Care Pharmacy Services and Strategy to develop an appropriate and aligned recommendation regarding accreditation. Lead all communications to practices.

  • Primary lead on assisting practices through any audit, credentialing or accreditation activities.

  • Maintain policy and procedure templates in order to leverage best practices and support practices in being compliant with payer expectations.

Minimum Requirements

Education/Training: 4-year degree in related field or equivalent experience

Business Experience: 5 years experience in project management.

Knowledge/Skills: Thorough knowledge of project management. Collaborative, customer-focused and able to create visible value.

Critical Skills

3 years PBM / physician dispensing experience preferred.

Expert knowledge of pharmacy script management and process flow.

2 years Intermediate project management, analysis and reporting skills.

2 Matrix management experience.

In depth knowledge of the pharmacy environment.

Proven ability to lead, persuade, and influence as it relates to customer relationships.

Experience and knowledge in audit, policy and procedures and credentialing.

Additional Knowledge & Skills

Thorough knowledge of project management. Collaborative, customer-focused and able to create visible value.

Ability to understand market research / customer needs and synthesize that information to identify best practices.

Strong understanding of dynamics within a medical office based pharmacy provider model.

Strong attention to detail.

A work record that demonstrates clear and effective communication skills, strong analytical skills, detail orientation, strategic agility and strong negotiation skills.

Strong organizational and interpersonal skills as well as ability to build lasting client relationships.

Self motivated and results oriented.

Ability to work under stress and deadlines.

Ability to travel on a regular basis.

Physical Requirements

General Office Demands

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.

Agency Statement

No agencies please.

Job: Project Management

Organization: McKesson Specialty Health

Title: Manager, Pharmacy Reimbursement Services (McKesson Specialty Health)

Location: Texas-The Woodlands

Requisition ID: 18006259