Reimbursement Specialist

4 weeks ago


Markham, Ontario, Canada Bayshore HealthCare Full time

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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