Reimbursement Specialist

1 week ago

Markham, Canada Bayshore HealthCare Full time

**About the Role**

The Reimbursement Specialist will provide drug coverage support to physicians and patients, follow up on submissions pertaining to obtaining coverage through private and provincial drug plans, ensure patients have access to their prescribed treatments in a timely manner, act as a resource to physicians who are prescribing this medication and provide continuous support for patients for renewals, and coverage changes

**A Day in the Life**
- Provide exemplary courteous professional service to all program stakeholders
- Works with Nurse Case Manager(s) to gather all pertinent and appropriate information to complete all necessary insurance forms (Private and/or Public) in a concise, organized, and professional manner
- Represent the patient with private or public insurers to optimize drug coverage and assist with the completion of Special Authorization (SA) and/or Prior Authorization (PA) forms, when applicable.
- Liaise and advocate with insurance providers and provincial governments as necessary 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. Troubleshoot 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 in keeping with the company's Quality Management System as well as key performance indicators for the program.
- Participate in proactive Health & Safety activities while performing all duties.
- Is responsible to notify immediate Supervisor of any Health & Safety risks or concerns.
- Maintain confidentiality of pharmaceutical partner(s) and corporate information and discusses same only with appropriate Bayshore personnel
- Complete other tasks as requested.

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 is an asset
- Understanding of provincial and private coverage criteria is an asset
- Familiarity with PIPEDA and how it applies in a confidential patient environment.
- Understanding of provincial and private coverage criteria, Special Authorization processes and how to navigate the Canadian drug coverage landscape is an asset
- Demonstrated expertise in delivering exceptional customer service and fostering positive relationships with internal and external stakeholders
- Must be fluent in verbal and written communication and interpersonal skills for both English and French (Applicable for provinces/regions with French language service requirements)
- Strong strategic thinking and problem-solving skills
- Ability to multi-task, prioritize and manage time effectively
- Ability to think under pressure
- Excellent computer skills; Microsoft Suite of products (minimum intermediate level Excel, Word, Power Point)
- Ability to work in a quiet working environment with proven ability to work autonomously within a remote/virtual team environment
- Established high speed internet access from home office.

  • Reimbursement Specialist

    1 week ago

    Markham, Canada Bayshore HealthCare Full time

    **About the Role** The Bayshore Specialty Rx Bilingual Reimbursement Specialist will provide reimbursement support to patients and physicians in collaboration with the Nurse Case Manager throughout the entire patient support program journey. The Reimbursement Specialist thrives in an environment that emphasizes teamwork, accountability, possesses a deep...

  • Reimbursement & Customer Experience Specialist

    4 days ago

    Markham, Canada Bayshore HealthCare Full time

    **ABOUT THIS ROLE**: Our Reimbursement & Customer Experience Specialist within the Diabetes Express department will support patients by providing an ultimate customer experience. This fast paced and rewarding role is ideal for self-motivated individuals who want to expand their experience in the health care industry. Our mission is to go above and beyond...

  • Bilingual Reimbursement

    2 weeks ago

    Markham, Canada Bayshore HealthCare Full time

    About the Role Under the supervision of the Associate Program Manager, the Bilingual Reimbursement/Client Care Specialist (CCS) will play an essential role in supporting patients living with a respiratory disease to improve both their health outcomes and quality of life. CCS will provide drug coverage support to physicians and patients, follow up on...

  • Reimbursement & Customer Experience Specialist

    1 week ago

    Markham, Canada Bayshore HealthCare Full time

    ABOUT THIS ROLE Our Customer Experience Specialist within the Diabetes Express department will support patients by providing an ultimate customer experience. This fast paced and rewarding role is ideal for self-motivated individuals who want to expand their experience in the health care industry. Our mission is to go above and beyond with each interaction...

  • Bilingual Reimbursement

    5 days ago

    Markham, Canada Bayshore HealthCare Full time

    **ABOUT THIS ROLE**: Our Bilingual Reimbursement & Customer Experience Specialist within the Diabetes Express department will support patients by providing an ultimate customer experience. This fast paced and rewarding role is ideal for self-motivated individuals who want to expand their experience in the health care industry. Our mission is to go above and...

  • Accounts Receivable Specialist

    1 week ago

    Markham, Canada J.D Barnes Full time

    J.D. Barnes Limited is searching for an Accounts Receivable Specialist to join our team! As an Accounts Receivable Specialist, you will be responsible for providing financial, administrative, and clerical services and ensuring the accuracy and efficiency of transactions. You will process and monitor incoming payments, verify, and post receipts. This position...

  • Marketing Specialist

    2 weeks ago

    Markham, Canada Greenergy Canada Full time

    MARKETING SPECIALIST REPORTING TO THE CONVENIENCE RETAIL BRAND MANAGER **Location**: MARKHAM, ON **About the company**: Across Canada, Greenergy operates a national gas and convenience retail network of over 240 locations, with a vast portfolio of brands as well as a strategic fuel supply network. Greenergy is the exclusive Mobil branded wholesaler and...

  • ERP Implementation Specialist

    7 days ago

    Markham, Canada Pacific Smoke International Inc Full time

    **ERP Implementation Specialist** **at Pacific Smoke International Inc.** Hybrid (1-2 days onsite) Do you believe that a company’s success depends on its people? If so, PSI is the place for you! PSI is nothing without the people who build, design, and support it. We’re looking for ERP Implementation Specialist to join our scaling organization and help...

  • Proposal Technical Specialist

    5 days ago

    Markham, Canada CES Transformers Full time

    **Job Scope**: The Technical Proposal Specialist is responsible for supporting the proposal design and management team, to promote and sell CES-manufactured transformer products to customers. This role involves understanding customer needs, analyzing and interpreting customer technical specifications, preparing technical and commercial proposal documents,...

  • Systems Configuration Specialist

    2 hours ago

    Markham, Canada Lean Industries Full time

    Systems Configuration Specialist Lean Industries (Lean Software Services, LSS Software Holdings) Lean Industries develops and delivers comprehensive enterprise software solutions designed to lower the costs and improve the quality of managing consumer and fraud disputes, exceptions and adjustments for electronic payment transactions. A highly configurable...