Specialty Pharmacy Reimbursement Specialist

1 month ago


Mississauga, Ontario, Canada The Cigna Group Full time
About the Role

The Specialty Pharmacy Reimbursement Representative plays a vital role in streamlining the financial and administrative processes associated with dispensing specialty medications.

Key Responsibilities
  1. Verify patient insurance coverage for specialty medications and maintain prior authorization tracking.
  2. Ensure that all documentation required by insurance providers is complete and accurate.
  3. Prepare and submit receipts for specialty medications to Patient Support Programs.
  4. Track and monitor the status of submitted drug claims to all Insurance Providers and Patient support programs.
  5. Investigate and resolve claim denials or discrepancies, liaising with internal and external stakeholders as needed.
  6. Work closely with pharmacists, physicians, and other healthcare providers to ensure seamless renewal of prescriptions.
  7. Facilitate communication between providers and insurance companies to expedite the reimbursement process.
  8. Maintain accurate records of all insurance verifications, claims submissions, and communications.
  9. Prepare reports on reimbursement activities and outcomes for management review.
  10. Assist in audits and compliance reviews related to reimbursement practices.
  11. Identify and resolve issues that may delay or prevent reimbursement.
  12. 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.


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