Analyst, Payor Performance

at  Shoppers Drug Mart Pharmaprix

Referred applicants must not apply directly to this role. All referred applicants must use their unique referral link generated when they are referred by an existing colleague.

SKILLS AND EXPERIENCE:

• A minimum of 1-3 years pharmacy experience, preferably in a retail, private payor, or audit environment
• Pharmacy Assistant/Technician certification or Undergraduate degree preferred, a degree in Healthcare or Analytics would be considered an asset
• Pharmacy Management System experience considered an asset (e.g., KROLL, HealthWATCH)
• An understanding of Third Party Payor drug plans, adjudication, and appeal processes as well as an understanding of pharmacy regulatory requirements, CHLIA guidelines, and CPhA Pharmacy Claim Standard is considered an asset
• Proficiency in Microsoft Office (Word, Excel, PowerPoint, etc.) to produce documents and reports
• High level of initiative to take projects from start to finish with minimal supervision
• Strong problem-solving ability and attention to detail
• Ability to work well independently and in a team environment
• Excellent time management and organizational skills
• Excellent verbal and written English communication skills. Ability to clearly communicate verbally and in writing to varying audiences
• Ability to work well independently and in a team environment

DUTIES AND RESPONSIBILITIES:

• Develop and execute the Payor Performance team’s goals and objectives by coordinating appeal responses to Third Party Payor auditors and inspectors on behalf of both Shoppers Drug Mart and Loblaw stores
• Support and maintain the appeal workflow for the Payor Performance team, including but not limited to reporting, monitoring, documentation gathering, results tracking
• Develop an extensive understanding of Third Party Payors in relation to adjudication issues, pharmacy manuals and audit processes
• Provide guidance on and assist in the resolution of issues that have been escalated from store-level and support teams relating to private and public payor audits and appeals
• Provide general support to stores and follow up with store pharmacy teams to communicate appeal results
• Support development of education and training documents related to Pharmacy Third Party Payors and their processes
• Monitor team shared mailbox and respond accordingly
• Provide administrative support related to Pharmacy Payors as required
• Support and collaborate on cross-functional pharmacy projects, as required
• Support ad-hoc pharmacy special projects to improve our pharmacy processes nationwide

TYPE OF ROLE:

Regular
Shoppers Drug Mart Inc. recognizes Canada’s diversity as a source of national pride and strength. We have made it a priority to reflect our nation’s evolving diversity in the products we sell, the people we hire, and the culture we create in our organization. Accommodation is available upon request for applicants with disabilities in the recruitment and assessment process and when hired.
In addition, we believe that compliance with laws is about doing the right thing. Upholding the law is part of our Code of Conduct – it reinforces what our customers and stakeholders expect of us.