Reimbursement Specialist
4 weeks ago
About the Role
The Reimbursement Specialist will play a crucial role in ensuring patients have access to their prescribed treatments in a timely manner. This involves providing drug coverage support to physicians and patients, following up on submissions pertaining to obtaining coverage through private and provincial drug plans, and acting as a resource to physicians who are prescribing this medication.
This is a contract role for up to 14 months, operated on a remote basis, and is open to candidates residing in various provinces across Canada.
A Day in the Life
- Provide exceptional customer service to all program stakeholders
- Work with Nurse Case Manager(s) to gather information and complete insurance forms in a concise and professional manner
- Represent patients with private or public insurers to optimize drug coverage and assist with the completion of Special Authorization and/or Prior Authorization forms, when applicable
- Liaise and advocate with insurance providers and provincial governments to determine coverage options
- Complete insurance appeals as required
- Follow-up and advocate until a decision is received to secure coverage for the patient
- Coordinate with pharmacy drug coverage and dispensing, troubleshooting any filling/billing issues as required
- 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
- Participate in proactive Health & Safety activities
- Maintain confidentiality of pharmaceutical partner(s) and corporate information
Job Qualification
What You Bring to the Team
- Completion of post-secondary education or equivalent
- Minimum 2 years of Canadian public and private reimbursement navigation and advocacy experience, within a patient program environment
- Understanding of provincial and private coverage criteria
- Familiarity with PIPEDA and how it applies in a confidential patient environment
- Strong strategic thinking and problem-solving skills
- Ability to multi-task, prioritize, and manage time effectively
- Excellent computer skills; Microsoft Suite of products
- Ability to work in a quiet working environment with proven ability to work autonomously within a remote/virtual team environment
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