Reimbursement Specialist

1 week ago

Hamilton, Ontario, Canada Charlton Health Group Full time $45,000 - $53,000 per year

We are growing We are seeking a highly skilled and detail-oriented Reimbursement Specialist to join our team. The ideal candidate will have extensive experience navigating the complex landscape of private and public insurance coverage systems within Ontario, Canada, with a strong emphasis on specialized therapeutic areas. This role is critical in helping patients access essential, advanced treatments by managing the end-to-end reimbursement process efficiently and accurately.

Key Responsibilities:

  • Case Management: Manage patient cases requiring coverage for advanced therapeutic treatments, specifically biologics and biosimilars, within the inflammatory bowel disease, rheumatological, dermatological, and general autoimmune condition domains.
  • System Navigation: Utilize expertise in healthcare administration software, specifically the TELUS Kroll system and the QHR Accuro EMR system, to process claims, verify coverage, and manage patient records efficiently.
  • Insurance Expertise: Act as the primary liaison between patients, healthcare providers, and insurance carriers (both public and private systems in Ontario) to secure coverage approvals and resolve claim denials.
  • Documentation & Compliance: Ensure all documentation, prior authorizations, and appeals are accurate, complete, and submitted in compliance with provincial and federal regulations.
  • Patient Advocacy: Provide empathetic support and clear communication to patients regarding their coverage options, potential costs, and the status of their reimbursement claims.
  • Knowledge Sharing: Stay current with changes in Ontario's drug coverage policies (e.g., ODB, private payer formularies) and specialized treatment protocols to proactively address access barriers.

Required Qualifications & Skills:

  • Disease State Knowledge: Strong foundational knowledge of complex disease states, including inflammatory bowel disease, rheumatological diseases, dermatological diseases, and autoimmune conditions.
  • Treatment Knowledge: Familiarity with advanced therapeutic treatments, including the reimbursement landscape for biologics and biosimilars.
  • Insurance Acumen: In-depth understanding of the interplay between private insurance plans and public drug coverage programs (e.g., ODB, Trillium Drug Program) in Ontario.
  • Communication: Excellent verbal and written communication skills, with a patient-first approach.
  • Attributes: Highly organized, detail-oriented, self-motivated, and capable of managing a high volume of complex cases independently.

Job Type: Full-time

Pay: $45,000.00-$53,000.00 per year

Benefits:

  • On-site parking

Application question(s):

  • Technical Proficiency:

Demonstrated working knowledge and proficiency with the TELUS Kroll system is essential.

Proficiency in the QHR Accuro EMR system is required.

Experience:

  • healthcare administration and reimbursement specialization : 1 year (required)
  • Advanced Therapeutic Medication: 1 year (preferred)

Location:

  • Hamilton, ON (preferred)

Work Location: In person

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