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Sarah Cannon Research Institute (SCRI) is one of the world’s leading oncology research organizations conducting community-based clinical trials. Focused on advancing therapies for patients over the last three decades, SCRI is a leader in drug development. In 2022, SCRI formed a joint venture with former US Oncology Research to expand clinical trial access across the country. It has conducted more than 850 first-in-human clinical trials since its inception and contributed to pivotal research that has led to the majority of new cancer therapies approved by the FDA in the past decade. SCRI’s research network brings together more than 1,300 physicians who are enrolling patients into clinical trials at more than 200 locations in 20+ states across the U.S.
Complex Care Reimbursement Specialist
Location
United States
Posted
81 days ago
Salary
$19 - $32 / year
Seniority
Mid Level
Job Description
Complex Care Reimbursement Specialist
McKesson
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. Key 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. Minimum 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. Education - Associate degree in healthcare administration, business, or related field preferred. - Relevant certifications in medical billing, coding, or reimbursement processes are a plus. Critical Skills - 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. Additional Preferred Experience - 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. Travel - Up to 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, please click here. Our Base Pay Range for this position $19.36 - $32.26 McKesson has become aware of online recruiting-related scams in which individuals who are not affiliated with or authorized by McKesson are using McKesson’s (or affiliated entities, like CoverMyMeds or RxCrossroads) name in fraudulent emails, job postings or social media messages. In light of these scams, please bear the following in mind: McKesson Talent Advisors will never solicit money or credit card information in connection with a McKesson job application. McKesson Talent Advisors do not communicate with candidates via online chatrooms or using email accounts such as Gmail or Hotmail. Note that McKesson does rely on a virtual assistant (Gia) for certain recruiting-related communications with candidates. McKesson job postings are posted on our career site: careers.mckesson.com. McKesson is an Equal Opportunity Employer McKesson provides equal employment opportunities to applicants and employees, without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, age, genetic information, or any other legally protected category. For additional information on McKesson’s full Equal Employment Opportunity policies, visit our Equal Employment Opportunity page. 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 (United States) Disability_Accommodation@McKesson.com or (Canada) Accessibility@mckesson.ca. Resumes or CVs submitted to this email box will not be accepted. Join us at McKesson!
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