Specialty Pharmacy Reimbursement Representative - Express Scripts Canada

at  The Cigna Group

The Specialty Pharmacy Reimbursement Representative plays a crucial role in facilitating the financial and administrative processes associated with dispensing specialty medications. The primary responsibilities involve handling insurance claims, verifying benefits, and ensuring that payments are processed efficiently and accurately.

QUALIFICATIONS:

• 1-2 years’ experience as a pharmacy assistant preferred.
• Experience with Drug claim reconciliation an asset
• Understanding of private and provincial insurance reimbursement for specialty medications.

KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:

• Demonstrated attention to detail in handling complex financial transactions and maintaining accurate records.
• Ability to clearly and compassionately communicate with patients, healthcare providers, and insurance representatives.
• Capable of addressing and resolving issues related to insurance claims and payments efficiently.
  Internal application deadline: October 30, 2024

• Verify patient insurance coverage for specialty medications and maintain prior authorization tracking.
• Ensure that all documentation required by insurance providers is complete and accurate.
• Prepare and submit receipts for specialty medications to Patient Support Programs
• Track and monitor the status of submitted drug claims to all Insurance Providers and Patient support programs.
• Investigate and resolve claim denials or discrepancies, liaising with internal and external stakeholders as needed.
• Work closely with pharmacists, physicians, and other healthcare providers to ensure seamless renewal of prescriptions
• Facilitate communication between providers and insurance companies to expedite the reimbursement process.
• Maintain accurate records of all insurance verifications, claims submissions, and communications
• Prepare reports on reimbursement activities and outcomes for management review.
• Assist in audits and compliance reviews related to reimbursement practices.
• Identify and resolve issues that may delay or prevent reimbursement.
• Collaborate with other team members to develop and implement solutions to complex reimbursement challenges and recommend process improvements to enhance efficiency and accuracy.