Reimbursement Specialist

POSITION SUMMARY:

Reporting to the Team Lead and/or Manager, the Reimbursement Associate will be primarily responsible for assisting our patients through insurance challenges and available provincial/federal programs to make their medications more affordable. The Reimbursement Navigator will also be responsible for certain aspects as it pertains to patient/care partner enrollment for the provision of reimbursement, scheduling, and drug ordering.

PRIMARY DUTIES AND RESPONSIBILITIES:

• Communicate with patients, prescribers, healthcare professionals and other key players to support patients through their treatment journey.
• Verify and investigate insurance coverage and benefits for patients, including eligibility, co-payments, deductibles, and prior authorizations.
• Gather and document information from patients/caregivers/prescribers in a concise, organized and professional manner.
• Complete, submit and follow-up on requisite paperwork in a timely manner.
• Liase with private and public insurance providers to determine coverage options
• Act as a central liaison for stakeholders such as physicians, nurses, patients, and clinics and provide required updates
• Maintain confidentiality of patient healthcare information
• Keep up to date with changes in insurance coverage and reimbursement policies and communicate these changes to healthcare providers and patients.
• Monitor treatments as well as chart and report on all activities are directed by Physician protocols.
• Provide patient education based on protocols, individually or in groups
• Regular, predictable availability to meet appointment scheduling needs in an efficient and cost-effective manner to provide patients with quick access to necessary therapies.
• Majority of the time, the role will be dedicated towards Reimbursement services
• The Reimbursement Associate will also be assigned other duties and tasks as required from time to time.

QUALIFICATIONS AND SKILLS:

• A college diploma or higher in a healthcare related course is an asset.
• Two or more years of reimbursement navigation experience involving private and public payers is mandatory.
• Two or more years of related pharmacy experience is an asset .
• Experience working with Patient Support Programs is an asset.
• Experience with Kroll Pharmacy Management System is an asset .
• Familiarity with the Special Authorization process for both public and private insurance in assigned territory .
• Proficiency in Microsoft Office Applications (Outlook, Word, Excel) .
• A demonstrated commitment to high professional ethical standards and a diverse workplace .
• Proven ability to work in a team environment and independently.
• Ease with working in a paperless environment.
• Time management skills and the ability to multi-task and adhere to deadlines.

Job Type: Full-time

Pay: $45,000.00-$55,000.00 per year

Benefits:

• Casual dress
• Company events
• Dental care
• Extended health care
• On-site parking
• Paid time off

Application question(s):

• This role will transition to a hybrid model after 3 months. Are you comfortable with that?
• Do you have any experience dealing with public and private insurance provider to secure coverage?

Experience:

• Reimbursement: 1 year (required)
• Speciality pharmacy: 1 year (required)

Work Location: In person