Reimbursement Specialist

at  Bayshore HealthCare

EDUCATION

• Completion of post-secondary education or equivalent

EXPERIENCE

• Minimum 2 years of Canadian public and private reimbursement navigation and advocacy experience, within a patient program environment is an asset
• Understanding of provincial and private coverage criteria is an asset
• Familiarity with PIPEDA and how it applies in a confidential patient environment.
• Understanding of provincial and private coverage criteria, Special Authorization processes and how to navigate the Canadian drug coverage landscape is an asset
• Demonstrated expertise in delivering exceptional customer service and fostering positive relationships with internal and external stakeholders
• Must be fluent in verbal and written communication and interpersonal skills for both English and French (Applicable for provinces/regions with French language service requirements)
• Strong strategic thinking and problem-solving skills
• Ability to multi-task, prioritize and manage time effectively
• Ability to think under pressure
• Excellent computer skills; Microsoft Suite of products (minimum intermediate level Excel, Word, Power Point)
• Ability to work in a quiet working environment with proven ability to work autonomously within a remote/virtual team environment
• Established high speed internet access from home office.

• 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