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The Cell and Gene Therapy (CGT) Lead Payer Specialist is an integral member of our healthcare team, dedicated to ensuring that CGT medications are accurately dispensed and reimbursed by insurance payers. This role requires a deep understanding of specialty pharmacy practices, rare disease management, and the complexities of cell and gene therapy treatments. The CGT Lead Payer Specialist will oversee the payer approval/payment process and contribute to payer contracting efforts.

This role is pivotal in ensuring that patients receive timely and appropriate access to innovative cell and gene therapies, mitigating financial and administrative barriers to treatment. The ideal candidate will possess a blend of clinical knowledge, insurance expertise, and a commitment to patient advocacy.

Key Responsibilities   

• Insurance Coordination: Work directly with insurance payers to secure pre-certifications, pre-authorizations, and approvals for CGT treatments. Navigate payer requirements, including step therapy protocols, adjunct HCPCS codes, and pre-medication authorizations.
• Payer Process Management: Oversee the cadence, complexity, and timing of steps necessary for coordination of payer approval through the therapy’s development process.
• Collaboration with providers to ensure insurance requirements are met facilitating payer treatment coverage.
• Stakeholder Engagement: Serve as a liaison between healthcare providers, payers, and the Biologics team to ensure an efficient approval and reimbursement process.
• Participant in payer contracting and negotiation efforts to ensure adequate coverage for the patient populations related to CGT access.

Minimum Requirement

• Degree or equivalent and typically requires 10+ years of relevant experience. Less years required if has relevant Master’s or Doctorate qualifications.

Critical Skills

• Minimum of 5 years in specialty pharmacy, rare diseases, or related industry services. At least 5 years of experience in stem cell transplant roles such as nurse navigator or other associated positions.
• Experience with working with insurance payers for pre-certification, pre-authorizations, step therapy, adjunct HCPCS codes, and payer requirements for therapy approval and pre-medications; as well as cadence, complexity, and timing of steps related to both outpatient and inpatient services supporting stem cell transplant and similar scenarios.
• Familiar with Would standard hospital Pharmacy and Therapeutics (P&T) protocol related to temporarily adding Cell and Gene Therapy products to hospital formulary prior to initiation of treatment for therapy to be covered by insurance benefits.
• Experience working with pharmaceutical manufacturers would be a plus, but not a strict requirement.
• Credentialed as a RN/BSN/PharmD, or BCOP.

• Experience in the specialty healthcare or pharmaceutical segment with understanding of healthcare continuum and relationship between manufacturers, patients, providers, and payers. Familiarity with cell and gene therapies and the associated reimbursement landscape is a plus.
• Knowledge of applicable healthcare laws and regulations, including HIPAA, Medicare, and Medicaid guidelines.
• Proficiency in Microsoft Office Suite, including Word, Excel, and PowerPoint

Specialized Knowledge and Skills

• 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 healthcare providers, and insurance companies.
• Ability to work effectively in a collaborative environment, collaborating with colleagues to achieve common goals.

• 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.
• Strong analytical and problem-solving skills, with the ability to identify and resolve issues related to treatment logistics.
• Critical thinking, analytical, and research capabilities.

Physical Requirements:

Office environment.  Less than 30% 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. 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

$154,200 - $257,000

McKesson is an Equal Opportunity Employer

 

McKesson provides equal employment opportunities to applicants and employees and is committed to a diverse and inclusive environment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, age or genetic information. For additional information on McKesson’s full Equal Employment Opportunity policies, visit our Equal Employment Opportunity page.

 

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