Complex Care Reimbursement Specialist

McKesson

1d•$19 - $32

About The Position

McKesson is an impact-driven, Fortune 10 company that touches virtually every aspect of healthcare. We are known for delivering insights, products, and services that make quality care more accessible and affordable. Here, we focus on the health, happiness, and well-being of you and those we serve – we care. What you do at McKesson matters. We foster a culture where you can grow, make an impact, and are empowered to bring new ideas. Together, we thrive as we shape the future of health for patients, our communities, and our people. If you want to be part of tomorrow’s health today, we want to hear from you. At Biologics by McKesson, we simplify access to medication and deliver personalized care that helps patients achieve the best possible outcomes—one patient, one partner, one therapy at a time. Position Summary We are seeking an experienced and highly motivated Cell and Gene Insurance Reimbursement Specialist to support patient access to life‑changing, ultra‑high‑cost therapies. This role requires deep knowledge of complex reimbursement environments—including therapies that often exceed six‑figure cost thresholds—and the ability to navigate evolving payer policies, coverage pathways, and authorization requirements. You will play a critical role in ensuring accurate and timely reimbursement for cell and gene therapies by partnering with patients, providers, payers, and internal teams to streamline the insurance process and remove barriers to access.

Requirements

5+ years of experience in specialty pharmacy, rare disease, hospital billing, infusion billing, or comparable healthcare reimbursement settings.
Proven experience handling high‑value or ultra‑high‑cost therapy reimbursements (e.g., cell and gene therapy, transplant, rare disease).
Strong understanding of medical billing, coding, payer policy, and insurance verification processes.
Experience in the specialty healthcare or pharmaceutical space and understanding of manufacturer‑provider‑payer dynamics.
Associate degree in healthcare administration, business, or related field preferred.
Strong knowledge of insurance coverage, reimbursement workflows, Medicare/Medicaid guidelines, and high-cost therapy benefit structures.
Exceptional communication skills with the ability to engage patients, providers, and payers effectively.
Strong analytical, research, and problem‑solving abilities, with a focus on resolving complex reimbursement issues.
Ability to prioritize, manage time effectively, and work both independently and collaboratively.
Proficiency in Microsoft Word, Excel, and PowerPoint.

Nice To Haves

Relevant certifications in medical billing, coding, or reimbursement processes are a plus.
Direct experience working with cell and gene therapy reimbursement.
Ability to build and maintain strong cross-functional relationships.
Comfort navigating ambiguity in a fast-evolving therapeutic and regulatory landscape.

Responsibilities

Insurance Verification & Coordination Verify insurance benefits and coverage for cell and gene therapies, including detailed review of pre‑authorization requirements, exclusions, and high‑cost carve‑outs.
Partner with healthcare providers, market access teams, patients, and payers to secure authorizations for complex, high-value therapies.
Appeals & Denials Management Collaborate with clinical case managers to manage appeals, resolve denials, and address payer escalations related to CGT coverage.
Navigate reimbursement scenarios involving stop‑loss coverage, specialty carve‑outs, and catastrophic case management.
Documentation & Reporting Maintain comprehensive documentation of reimbursement activities, claim statuses, payer responses, and reimbursement outcomes.
Prepare reports to support internal operations, leadership, and patient-facing teams.
Regulatory & Policy Compliance Stay informed on evolving regulations, payer policies, and CMS/Medicare/Medicaid guidance related to cell and gene therapy reimbursement.
Ensure compliance with all healthcare laws, including HIPAA.
Patient Support Provide clear, empathetic guidance to patients and caregivers regarding coverage, reimbursement timelines, and available financial assistance options.
Cross-Functional Collaboration Work closely with clinical teams, billing, market access, data analytics, and patient advocacy groups to streamline reimbursement workflows and improve patient access.