Pharmaceutical Reimbursement Professional

1 week ago

Mississauga, Ontario, Canada The Cigna Group Full time

Job Overview:

The Pharmaceutical Reimbursement Professional plays a vital role in ensuring the efficient and accurate reimbursement of specialty medications. This position requires strong attention to detail, effective communication skills, and the ability to navigate complex financial transactions.

Main Responsibilities:

  • Verify patient insurance coverage for specialty medications and maintain prior authorization tracking.
  • Ensure that all documentation required by insurance providers is complete and accurate.
  • Prepare and submit receipts for specialty medications to Patient Support Programs.
  • Track and monitor the status of submitted drug claims to all Insurance Providers and Patient support programs.
  • Investigate and resolve claim denials or discrepancies, liaising with internal and external stakeholders as needed.
  • Work closely with pharmacists, physicians, and other healthcare providers to ensure seamless renewal of prescriptions.
  • Facilitate communication between providers and insurance companies to expedite the reimbursement process.
  • Maintain accurate records of all insurance verifications, claims submissions, and communications.
  • Prepare reports on reimbursement activities and outcomes for management review.
  • Assist in audits and compliance reviews related to reimbursement practices.
  • Identify and resolve issues that may delay or prevent reimbursement.
  • Collaborate with other team members to develop and implement solutions to complex reimbursement challenges and recommend process improvements to enhance efficiency and accuracy.

Requirements:

  • 1-2 years' experience as a pharmacy assistant preferred.
  • Experience with Drug claim reconciliation an asset.
  • Understanding of private and provincial insurance reimbursement for specialty medications.

Compensation: The estimated salary range for this position is $65,000 - $80,000 per year, depending on experience and qualifications.

About Express Scripts Canada: As a leading health benefits manager, we work with clients to develop industry-leading solutions to deliver superior healthcare in a cost-controlled environment. Our proprietary consumer intelligence, clinical expertise, and patients-first approach promote better health decisions for plan members while managing and reducing drug benefit costs for plan sponsors.

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