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Bilingual Senior Reimbursement Specialist

2 months ago

Markham, Canada Bayshore HealthCare Full time

About the Role


In addition to the Senior Reimbursement Specialist responsibilities listed within the duties and responsibilities, the SRS will also be the point of contact offering support to physicians for appealing public and private denials for patients. Assist physicians with the completion of all program specific paperwork and follow-up on submissions pertaining to obtaining drug access through various means to ensure patients have access to their prescribed treatments in a timely manner. Act as a resource for all reimbursement queries to physicians who are prescribing this medication and continuous support for patients for complete reimbursement management in relation to the program.


This role is operated on a remote basis and is open to candidates that reside in Alberta, British Columbia, Manitoba, New Brunswick, Newfoundland and Labrador, Nova Scotia, Ontario, Prince Edward Island, Quebec, Saskatchewan, Northwest Territories, Nunavut, and Yukon.


A Day in the Life

  1. Assist management in creating WI and proactively identify how to improve processes and operations
  2. Work closely with management and National Lead of Reimbursement to assess and develop team trainings for reimbursement
  3. Act as a central reimbursement resource liaison for the team
  4. Participate in the training and onboarding of new hires
  5. Attend leadership or client meetings as directed by direct manager
  6. Provide exemplary courteous professional service to all program stakeholders
  7. Work with Nurse Case Manager(s) to gather all pertinent and appropriate information to complete all necessary insurance forms (Private and/or Public) in a concise, organized, and professional manner
  8. Represent the patient with private or public insurers to optimize drug coverage and assist with the completion of Special Authorization (SA) and/or Prior Authorization (PA) forms, when applicable.
  9. Liaise and advocate with insurance providers and provincial governments as necessary to determine coverage options
  10. Complete insurance appeals as required
  11. Follow-up and advocate until a decision is received to secure coverage for the patient
  12. Coordinate with pharmacy drug coverage and dispensing. Troubleshoot any filling/billing issues as required
  13. Provide ongoing support and assistance to ensure patient adherence
  14. Identify, report and document Adverse Events as per Pharmacovigilance requirements
  15. Adhere to Bayshore Policies and Procedures
  16. Participate in quality activities and continuous improvement initiatives in keeping with the company's Quality Management System as well as key performance indicators for the program.
  17. Participate in proactive Health & Safety activities while performing all duties.
  18. Notify immediate Supervisor of any Health & Safety risks or concerns.
  19. Maintain confidentiality of pharmaceutical partner(s) and corporate information and discuss same only with appropriate Bayshore personnel
  20. Complete other tasks as requested.

Qualifications


What You Bring to the Team

  1. Completion of post-secondary education or equivalent
  2. 3-5 years of experience in Canadian public and private landscapes specifically within patient support programs
  3. Minimum 2 years of Canadian public and private reimbursement navigation and advocacy experience, within a patient program environment is an asset
  4. Understanding of provincial and private coverage criteria is an asset
  5. Familiarity with PIPEDA and how it applies in a confidential patient environment.
  6. Demonstrated expertise in delivering exceptional customer service and fostering positive relationships with internal and external stakeholders
  7. Must be fluent in verbal and written communication and interpersonal skills for both English and French (Applicable for provinces/regions with French language service requirements)
  8. Strong strategic thinking and problem-solving skills
  9. Ability to multi-task, prioritize and manage time effectively
  10. Ability to think under pressure
  11. Excellent computer skills; Microsoft Suite of products (minimum intermediate level Excel, Word, Power Point)
  12. Ability to work in a quiet working environment with proven ability to work autonomously within a remote/virtual team environment
  13. Established high speed internet access from home office.
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