Pharmacy Reimbursement Coordinator

Job Category : Pharmacy

Requisition Number : PHARM001882

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• Posted : May 7, 2024
• Full-Time

Showing 1 location

Markham, ON L3R9W7, CAN

Position Type: Full Time

Department: Pharmacy

Work Location: Markham, ON

Work Arrangement : Hybrid

Work Hours: Standard Business Hours Monday to Friday

Travel Required: No

A proudly Canadian company, Sentrex Health Solutions is a fully integrated specialty distributor and patient support provider for pharmaceutical manufacturers, physicians, and their patients. We provide innovative solutions focused on ensuring patients have access and the support they need to maximize their treatment outcomes. We do this through strategic distribution models and patient support programs that are backed by powerful, integrated technology, a dedicated in-house creative agency, and experienced, cross-functional teams. Our core capabilities include Specialty Pharmacy Services, Customized Solutions for Warehouse, Wholesale & Distribution, Patient Support Programs, Strategic Creative Services as well as HCP & Clinic Services.

Come and join our team But first, let us tell you why we love working here:

• We are 100% Canadian with locations across the country
• State-of-the-art facilities to provide high-quality products and services
• The opportunity to be a part of a winning, high-performing team
• Collaborative, engaging workplace culture – we are passionate about our people
• Flexible working environment that promotes a healthy work-life balance
• Diverse and inclusive culture where your talent and commitment to excellence is welcomed and valued
• High-growth environment that provides opportunities for learning and growth supported by our Employee Development Program and industry-leading, in-house corporate training offered throughout the year
• Quarterly virtual social events

The Opportunity:

The Pharmacy Reimbursement Coordinator has primary responsibility for ensuring that retina prescriptions are filled and reimbursed in a timely manner. This role will lead the pharmacy, provider solutions and patient support programs teams to actively resolve "unfilled" prescriptions by investigating the reason why the prescription was not filled and taking action to have the prescription filled. This includes ensuring enrollment and special authorization forms are completed, compassionate/free goods dose replacements are received, prescriptions are billed to an appropriate third party, and/or alternate covered therapy is arranged. While the primary focus for the role is ophthalmology prescriptions, the Pharmacy Reimbursement Coordinator will also be responsible for other programs that require reimbursement support.

The Pharmacy Reimbursement Coordinator will report regularly on the status of outstanding prescriptions and ensure that all KPI targets for outstanding prescriptions are met.

The Pharmacy Reimbursement Coordinator is expected to participate in all aspects of Sentrex Pharmacy required of a team player. All roles at Sentrex Pharmacy may be cross trained as permitted by scope of practice, and you may be required to help in other areas of the pharmacy.

A Day in the Life (What you will do here):

• Responsible for investigating why prescriptions have not been filled, identifying what actions need to be taken to fill the prescription and ensuring those actions are performed
• Lead regular meetings regarding unfilled prescriptions with key stakeholders
• Communicate and coordinate follow up with patient support programs, provider solutions team, physician clinics and patients to ensure that patient enrollment and/or special authorization forms are processed in a timely manner
• Resolve billing issues with third party adjudicators related to unfilled prescriptions
• Ensure that Retina program prescriptions are billed to an appropriate third party or that compassionate replacement doses are received
• Ensure the unfilled/problem prescription queues in Kroll, the Retina/LuminavPro portal and other systems are updated with accurate information in a timely manner
• Prepare regular reports on the status of unfilled prescriptions
• Ensure all KPIs for unfilled prescriptions are met/exceeded
• Adherence to all relevant guidelines including the established Standard Operating Procedures and all applicable regulatory requirements as set out by the provincial College of Pharmacy
• Actively contribute to the ongoing review of policies and procedures as they pertain to pharmacy operations
• Attends and participates in staff meetings
• Perform other duties as assigned by manager

What you need to ensure you are set up for success:

• Strong verbal and written communication skills in English required. Ability to communicate in French is an asset.
• Strong understanding of third party insurance plans and reimbursement concepts
• Previous experience working in a pharmacy setting and/or with patient support programs an asset
• Proficiency with Kroll required
• Highly organized with strong attention to detail
• Ability to self-manage time, set daily priorities and multi-task to meet various competing work deadlines
• Excellent interpersonal skills, with ability to work independently as well as within a team

What makes you a great fit for this team:

• Your commitment to providing a high level of service to your internal and external clients.
• You are highly adaptable with a track record of success during times of growth and organizational change.
• You have a proven track record of developing trust and influence at multiple levels.
• You demonstrate an impactful and candid communication style.
• You have exceptional organizational skills with the ability to build effective working relationships with colleagues, management, and stakeholders.

We value our employees Our permanent full-time employees are provided with a:

• Competitive Salary and generous vacation entitlement
• Wellness Program (5 paid days off for your well-being)
• Paid Sick Days
• Competitive Benefits Package including Dental & Extended Health Benefits, AD&D, LTD & Employee/Dependent Life Insurance
• Employee & Family Assistance Program

Sentrex Health Solutions is proud to be an equal opportunity employer demonstrated by our commitment to diversity, inclusion, belonging, equity, and accessibility. We provide a safe space for all team members to express their individuality within our corporate culture.

We encourage you to apply and accept all applications. We realize that not every candidate will meet every single desired qualification. If your experience looks a little different from what we have identified and you think you can bring value to the role, we would love to learn more about you

Accommodations can be made available upon request for those candidates taking part in the selection process.

Sentrex Health Solutions recognizes the importance of immunization to protecting our staff, customers, and members of the community from COVID-19. As such, and subject to any obligations under applicable human rights legislation, it will be a condition of employment that all new hires have received all required doses of a COVID-19 vaccine approved by Health Canada. Successful applicants will be required to provide proof of full vaccination prior to their start date.