Bilingual Reimbursement Specialist

2 weeks ago

Quebec City, Canada Bayshore HealthCare Full time

**ABOUT THE ROLE**
The Bayshore Specialty Rx Bilingual Reimbursement Specialist will provide reimbursement support to patients and physicians in collaboration with the Nurse Case Manager throughout the entire patient support program journey. The Bilingual Reimbursement Specialist thrives in an environment that emphasizes teamwork, accountability, possesses a deep willingness to serve customers and drives positive customer and patient experience in a fast-paced work environment.
- This is a contract role until July 2024._

**A DAY IN THE LIFE**
- Provide exemplary courteous professional service to all program stakeholders
- Works with Nurse Case Manager to gather all pertinent and appropriate information to complete all necessary insurance forms (Private and/or Public) in a concise, organized, and professional manner
- Liaise and advocate with insurance providers and provincial governments as necessary to determine coverage options
- Complete insurance appeals as required
- Follow-up/advocate until a decision is received to secure coverage for the patient
- Assess patient for reimbursement program support as required
- Coordinate with pharmacy drug coverage and dispensing. Troubleshoot any filling/billing issues as required
- Liaise and advocate with third party providers
- Provide ongoing support and assistance to ensure patient adherence
- Identify, report and document Adverse Events as per Pharmacovigilance requirements
- Participate in ongoing internal and/or external continuing education activities
- Adhere to Bayshore Policies and Procedures
- 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.
- Participate in proactive Health & Safety activities while performing all duties. Is responsible to notify immediate Supervisor of any Health & Safety risks or concerns.
- Maintain confidentiality of client and corporate information and discusses same only with appropriate Bayshore personnel
- Complete other tasks as requested.

Job Qualification

**WHAT YOU BRING TO THE TEAM**
- Minimum 2 years of Canadian public and private reimbursement navigation and advocacy experience, within a patient program environment, ideally with PA/SA drugs for chronic diseases is preferred.
- Understanding of provincial and private coverage criteria
- Familiarity with the Special Authorization process for both public and private insurance.
- Bilingual French/English Required
- Experience in immunology considered an asset
- Familiarity with PIPEDA and how it applies in a confidential patient environment.
- Understanding of provincial and private coverage criteria and how to navigate the Canadian Drug Coverage Landscape.
- Experience in identifying and reporting adverse events to health Canada and Medical Information
- Strong strategic thinking and problem-solving skills
- Ability to multi-task, prioritize and manage time effectively
- Strong problem-solving skills and the ability to think under pressure
- Excellent computer skills; Microsoft Suite of products (minimum intermediate level Excel, Word, Power Point)
- Bayshore is committed to a high quality and safe environment for both our staff and clients/patients. At Bayshore all new hires must have received the full series of a COVID-19 vaccine or combination of COVID-19 vaccines approved by Health Canada (e.g., two doses of a two dose vaccine series or one dose of a single
- dose vaccine series); AND have received the final dose of the COVID-19 vaccine at least 14 days prior to the official start date of hire. Medical exemptions or any other kinds of requested exemptions based upon Human Rights Code will be considered on a case-by-case basis._
- Bayshore operates in accordance with the Accessibility for Ontarians with Disabilities Act, 2005 and applicable Provincial Human Rights Code._

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