Reimbursement/client Care Specialist

2 weeks ago

Mississauga, Canada Bayshore HealthCare Full time

**About the Role**:
Under the supervision of the Associate Program Manager, the Reimbursement/Client Care Specialist (CCS) will play an essential role in supporting patients living with a respiratory disease to improve both their health outcomes and quality of life. CCS will provide drug coverage support to physicians and patients, follow up on submissions pertaining to obtaining coverage through private and provincial drug plans, ensure patients have access to their prescribed treatments in a timely manner, act as a resource to physicians who are prescribing this medication, and provide continuous support for patients for renewals, and coverage changes.

**A Day in the Life**:
Gather all pertinent and appropriate information from the chart to complete the necessary forms (private and/or provincial insurance) in a concise, organized, and professional manner
Liaise and advocate with insurance providers and provincial governments as necessary to determine coverage options
Keep detailed notes in the patient’s electronic chart
Follow up/advocate until a decision is received to secure coverage for the patient
Complete and/or review Prior Authorization (PA) or Special Authorization (SA) forms prior to submission to insurers
Coordinate and gather the necessary information to ensure timely and accurate delivery of the specialty drug
Coordinate and schedule patients at appropriate injection location (home, clinic, etc.)
Act as a resource for program stakeholders, which include physicians, nurses, patients, clinics, and the client
Assist with data integrity/rounds as required
Communicate with patients regarding their third-party insurance provider, or public coverage provider, to resolved billing issues
Communicate with patients’ third-party plans, or public coverage provider, to troubleshoot rejected claims
Assist the pharmacist in entering prescriptions into the prescription software (Kroll), and filling/billing such prescriptions
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
Must be able to identify and report Adverse Events to Health Canada, Med Info, and enter into source system and third-party systems
Participate in proactive Health & Safety activities while performing all duties. Is responsible to notify immediate supervisor of any Health & Safety risks or concerns. Responsible for completing Accident Reports for all direct reports who injure themselves on the job, within 24 hours of the incident.
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
Understanding of provincial and private coverage criteria
Familiarity with the Special Authorization process for both public and private insurance
Strong computer and software skills: Excel, Word, Outlook, Adobe Acrobat, CRM database entry, VOIP telephony, web portals, teleconferences, web-based meetings, Kroll and/or other pharmacy-related software systems
Ease with working independently, “playing detective,” making decisions using sound judgment, and meeting deadlines
Ease with working in a paperless environment
Excellent written and verbal communication skills in English
Familiarity with PIPEDA and how it applied

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