Reimbursement Specialist
Bayshore HealthCare
Full time
Healthcare
Canada
Hiring from: Canada
Duties And Responsibilities
Ontario
- 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.
- Completion of post-secondary education or equivalent.
- 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.
Ontario
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