Reimbursement Specialist

at  Bayshore HealthCare

A DAY IN THE LIFE

• Provide exemplary courteous professional service to all program stakeholders
• Works with Nurse Case Manager(s) to gather all pertinent and appropriate information to complete all necessary insurance forms (Private and/or Public) in a concise, organized, and professional manner
• Represent the patient with private or public insurers to optimize drug coverage and assist with the completion of Special Authorization (SA) and/or Prior Authorization (PA) forms, when applicable.
• Liaise and advocate with insurance providers and provincial governments as necessary to determine coverage options
• Complete insurance appeals as required
• Follow-up and advocate until a decision is received to secure coverage for the patient
• Coordinate with pharmacy drug coverage and dispensing. Troubleshoot any filling/billing issues as required
• Provide ongoing support and assistance to ensure patient adherence
• Identify, report and document Adverse Events as per Pharmacovigilance requirements
• Participate in ongoing internal and/or external continuing education activities
• Adhere to Bayshore Policies and Procedures
• Participate in quality activities and continuous improvement initiatives in keeping with the company’s Quality Management System as well as key performance indicators for the program.
• Participate in proactive Health & Safety activities while performing all duties.
• Is responsible to notify immediate Supervisor of any Health & Safety risks or concerns.
• Maintain confidentiality of pharmaceutical partner(s) and corporate information and discusses same only with appropriate Bayshore personnel
• Complete other tasks as requested.
  Job Qualification

The Reimbursement Specialist will provide drug coverage support to physicians and patients, follow up on submissions pertaining to obtaining coverage through private and provincial drug plans, ensure patients have access to their prescribed treatments in a timely manner, act as a resource to physicians who are prescribing medications and provide continuous support for patients for renewals, drug switches and coverage changes.
This role is operated on a remote basis and is open to candidates that reside in Alberta, British Columbia, Manitoba, New Brunswick, Newfoundland and Labrador, Nova Scotia, Ontario, Prince Edward Island, Quebec, Saskatchewan, Northwest Territories, Nunavut, and Yukon.