Reimbursement Specialist
3 months ago
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 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
DUTIES AND RESPONSIBILITIES
- 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
QUALIFICATIONS & EXPERIENCE
- 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.
- 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)
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