Bilingual Reimbursement Specialist

4 days ago

Mississauga ON LB M, 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:

  • Receive, handle and follow-up on Coverage Navigation applications
  • 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
  • Ensure continuity of care for cases is maintained and that any changes in application progress are clearly identified and transitioned accordingly
  • 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
  • Must be bilingual (English/French)
  • 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

Employment is contingent upon the successful completion of a background check/police record check.

Job Type: Contract

Contract length: 17 months

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

Benefits:

  • Wellness program
  • Work from home

Experience:

  • Retail Pharmacy: 2 years (required)

Language:

  • English and French (required)

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

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