Reimbursement Specialist

Job summary

The Reimbursement Specialist provides drug coverage support to patients and physicians by navigating private and provincial insurance plans. They also manage patient electronic charts, advocate for coverage decisions, and ensure compliance with pharmacovigilance and regulatory reporting requirements.

Job details

This is a contract position with an anticipated end date of November 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. • 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. • Must be able to identify and report Safety Events (Adverse Events, Product Quality Complaints, Special Situations) to relevant entities (eg. Health Canada, Med Info, PV team) and in conjunction with the Pharmacovigilance Department assures the identification, datacollection into source system and third-party systems, processing and reporting of Safety Events are within contractual KPI’s and pharmacovigilance requirements. • 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. • Familiarity with PIPEDA and how it applies in a confidential patient environment. At Bayshore Healthcare, our commitment to Equity, Diversity & Inclusion is our strength. This is how we bring our vision of being the difference in the lives of those we care for, work with and in our communities. We have a great sense of pride in creating a culture of belonging, where individual differences are embraced and celebrated, through programs, resources and policies that support each individual's purpose, potential and wellbeing. At Bayshore Healthcare Ltd., and its subsidiaries, we are committed to fostering an inclusive workplace and operate in full compliance with all Provincial and Territorial legislation pertaining to Human Rights Codes and Accessibility requirements. To ensure continued compliance throughout the recruitment and selection process, we encourage candidates to disclose any accommodation needs they may have.

What you’ll do

The Reimbursement Specialist provides drug coverage support to patients and physicians by navigating private and provincial insurance plans. They also manage patient electronic charts, advocate for coverage decisions, and ensure compliance with pharmacovigilance and regulatory reporting requirements.

Requirements

Candidates must have at least 2 years of experience in Canadian public and private reimbursement navigation within a patient program environment. Proficiency in insurance coverage criteria, Special Authorization processes, and strong computer skills including CRM and Microsoft Office are required.

Listed skills

• Microsoft Excel · Preferred
• Microsoft Outlook · Preferred
• Communication · Preferred

Other relevant skills

Identified from the job description. Confirm important requirements above.

• Reimbursement navigation
• Insurance advocacy
• Drug coverage support
• Patient advocacy
• Electronic chart management
• Special Authorization forms
• Data integrity
• Pharmacovigilance
• Regulatory reporting
• Health and safety compliance
• CRM database entry
• Microsoft Excel
• Microsoft Outlook
• Adobe Acrobat
• PIPEDA compliance
• Communication
• Authorization (Computing)
• Key Performance Indicators (KPIs)
• Continuous Improvement Process
• Program Management
• Customer Relationship Management
• Professionalism
• Advocacy
• Ability To Meet Deadlines
• Product Quality (QA/QC)
• Confidentiality
• Data Integrity
• Chronic Diseases
• Workplace Inclusivity
• Quality Management Systems
• Good Clinical Practices (GCP)
• Accident Reporting
• Web Portals
• Good Pharmacovigilance Practices (GVP)
• Financial Assistance

Job areas

• Healthcare
• Administrative
• Customer Service & Support
• Reimbursement Specialist
• Clinical Data Specialist
• Medical Records and Health Information Technicians
• Clinical Data Managers
• Data Scientists

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