Specialty Pharmacy Reimbursement Coordinator

2 months ago


Mississauga, Ontario, Canada The Cigna Group Full time

Job Summary

The Specialty Pharmacy Reimbursement Representative plays a vital role in ensuring the efficient and accurate processing of insurance claims for specialty medications. This position requires strong communication and problem-solving skills to resolve claim denials and discrepancies.

Key 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.

Qualifications:

  • 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.

About The Cigna Group

The Cigna Group is a global health service company dedicated to improving the health, wellbeing and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioural health, pharmacy, vision, supplemental benefits, and other related products.

Why Join Us

We are an equal opportunity employer that promotes a diverse, inclusive and accessible workplace. By embracing diversity, we build a more effective organization that empowers our employees to be the best that they can be.



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