Reimbursement Specialist

2 weeks ago

Mississauga, Canada ClaimSecure Full time

Reporting to the Team Lead of Clinical Pharmacists, the Coverage Navigation Specialist is responsible for day-to-day operations supporting the Clinical Services team.

**Principal Responsibilities**:

- Manage all aspects required to obtain prescription drug coverage for patients
- Maintain communication between internal and external stakeholders
- Coordinate cases with public and private payers, physician offices, pharmacies, and other relevant healthcare providers in order to maximize reimbursement options
- Coordinate all documents and related paperwork to private and public payers, as needed
- Liaise with internal stakeholders for report generation
- Respond to client inquiries related to Coverage Navigation cases and provide status updates
- Act as the primary resource of contact for members, internal partners and external clients
- Maintain high standards of professional practice by adhering to the ethics of the profession and keeping abreast of the latest professional advances
- Monitor Coverage Navigation cases to ensure goals are met on daily, monthly and quarterly basis
- Provide written and verbal communication to members, clients, and internal partners
- Identify process gaps, develop strategies to overcome operational challenges, and implement new processes as required
- Assume responsibility for personal and professional development
- Acquire and maintain extensive knowledge of private and provincial funding

**Knowledge, skills and experience**:

- Post-secondary education e.g., BSc and/or RPhT diploma
- Minimum 2 years’ experience working in pharmacy setting
- Bilingualism (English/French) is an asset
- Previous experience in pharmacy benefit management, insurance, and/or reimbursement is preferred
- Solid understanding of provincial and private drug plans for medication access
- Working knowledge of MS Office Applications - Word, Excel, PowerPoint
- Ability to organize, coordinate and prioritize own work
- Demonstrated capacity to liaise in a constructive and collaborative fashion with a variety of healthcare providers, clients and staff at various organizational levels
- Demonstrated strong ability to effectively communicate (verbal, written and presentation)
- Excellent analytical and problem solving skills
- Demonstrated critical thinking, problem solving skills and attention to detail
- Demonstrated commitment to collaborative practice and lifelong learning

**Job Types**: Full-time, Contract, Permanent
Contract length: 18 months

Pay: $51,000.00-$56,000.00 per year

**Benefits**:

- Casual dress
- Company events
- Dental care
- Disability insurance
- Employee assistance program
- Extended health care
- Flexible schedule
- Life insurance
- Paid time off
- RRSP match
- Vision care
- Wellness program
- Work from home

**Experience**:

- Retail Pharmacy: 2 years (required)

Work Location: Hybrid remote in Mississauga, ON L5B 1M2

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