Reimbursement/Client Care Specialist (Remote)

About The Role

Under the supervision of the Associate Program Manager, the Reimbursement/Client Care Specialist (CCS) will play an essential role in supporting patients living with a respiratory disease to improve both their health outcomes and quality of life. CCS 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.

A Day In The Life

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

Complete and/or review Prior Authorization (PA) or Special Authorization (SA) forms prior to submission to insurers

Coordinate and gather the necessary information to ensure timely and accurate delivery of the specialty drug

Coordinate and schedule patients at appropriate injection location (home, clinic, etc.)

Act as a resource for program stakeholders, which include physicians, nurses, patients, clinics, and the client

Assist with data integrity/rounds as required

Communicate with patients regarding their third-party insurance provider, or public coverage provider, to resolved billing issues

Communicate with patients’ third-party plans, or public coverage provider, to troubleshoot rejected claims

Assist the pharmacist in entering prescriptions into the prescription software (Kroll), and filling/billing such prescriptions

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

Must be able to identify and report Adverse Events to Health Canada, Med Info, and enter into source system and third-party systems

Participate 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.

Maintain confidentiality of client and corporate information and discusses same only with appropriate Bayshore personnel

Complete other tasks, as requested

What You Bring To The Team

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, Kroll and/or other pharmacy-related software systems

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

Familiarity with PIPEDA and how it applied

Primary Location

ON-Mississauga