Reimbursement Specialist at Bayshore Specialty Rx

Mississauga, Ontario, Canada -

Full Time

Start Date

Immediate

Expiry Date

15 Sep, 26

Salary

0.0

Posted On

17 Jun, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Reimbursement Navigation, Insurance Advocacy, Special Authorization Process, Patient Program Management, CRM Database Entry, Medical Charting, Regulatory Reporting, Pharmacovigilance, Microsoft Excel, Microsoft Word, Adobe Acrobat, English Communication, French Communication, PIPEDA Compliance, Data Integrity, Patient Support

Industry

Hospitals and Health Care

Description

This is a contract role with an expected end date in June 2027. JOB SUMMARY Under the supervision of the Associate Program Manager, 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 this medication and provide continuous support for patients for renewals, and coverage changes. DUTIES AND RESPONSIBILITIES • Gather all pertinent and appropriate information from the chart to complete the necessary forms (private and/ or provincial insurance) in a concise, organized, and professional manner. • Liaise and advocate with insurance providers and provincial governments as necessary to determine coverage options. • Keep detailed notes in the patient’s electronic chart. • Follow-up/ advocate until a decision is received to secure coverage for the patient. • Completes and/ or reviews SA forms prior to submission to insurers. • Proactively offer financial assistance for patients. • Act as a resource for program stakeholders, which include physicians, nurses, patients and clinics and the client. • Assist with data integrity/ rounds as required. • 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. • Employee will maintain relevant level of knowledge of ICH (International Conference of Harmonization), GCP (Good Clinical Practice) and Health Canada GVP (Good Pharmacovigilance Practices) guidelines appropriate to their hired role which is to be provided at the time of hire and annually. With this knowledge the employee will perform the work as required by their assigned function and will be provided with regular updates as required. • Must be able to identify and report AEs to Health Canada, Med Info and enter into source system and third-party systems. • Participate in processes relating to regulatory reporting requirements. • Participates in proactive Health & Safety activities while performing all duties. Is responsible to notify immediate supervisor of any Health & Safety risks or concerns. Responsible for completing Accident Reports for all direct reports who injure themselves on the job, within 24 hours of the incident. • Maintains confidentiality of client and corporate information and discusses same only with appropriate Bayshore personnel. • Complete other tasks as requested. QUALIFICATIONS • Familiarity with PEPEDA and how it applies in a confidential patient environment. • Minimum 2 years of Canadian public and private reimbursement navigation and advocacy experience, within a patient program environment, ideally with PA/SA drugs for chronic diseases. • Understanding of provincial and private coverage criteria • Familiarity with the Special Authorization process for both public and private insurance. • Strong computer and software skills: Excel, Word, Outlook, Adobe Acrobat, CRM database entry, VOIP telephony, web portals, teleconferences, web-based meetings. • Ease with working independently, “playing detective,” making decisions using sound judgment, and meeting deadlines. • Ease with working in a paperless environment. • Excellent written and verbal communication skills in English and French is an asset. • Familiarity with PIPEDA and how it applies in a confidential patient environment.

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Responsibilities

The Reimbursement Specialist provides drug coverage support to physicians and patients by managing submissions for private and provincial drug plans. They act as a resource for stakeholders to ensure timely access to prescribed treatments and maintain detailed patient records.