Drug Coverage & Access Advocate

Bayshore HealthCare; Mississauga; On-site; CAD 60,000 - 85,000; Full time

Job summary

Bayshore HealthCare in Mississauga is seeking a Reimbursement Specialist to support physicians and patients with drug coverage, navigate private and provincial plans, and ensure timely access to prescribed treatments. The role involves advocacy with insurers, maintaining patient records, and supporting renewals and coverage changes.

The ideal candidate has 2+ years in reimbursement navigation, strong software skills, and a good grasp of provincial/private criteria, PIPEDA, and health

Qualifications

• Minimum 2 years of Canadian public and private reimbursement navigation and advocacy experience.
• Understanding of provincial and private coverage criteria.
• Familiarity with the Special Authorization process for both public and private insurance.
• Strong computer skills: Excel, Word, Outlook, Adobe Acrobat, CRM database entry, VOIP telephony, web portals.
• Ability to work independently, make sound decisions, and meet deadlines.
• Familiarity with PIPEDA and confidential patient environments.

Responsibilities

• Gather all pertinent information from the chart to complete forms for private or provincial insurance.
• Advocate with insurance providers and government bodies to determine coverage options.
• Maintain detailed notes in the patient’s electronic chart.
• Follow up until coverage decisions are received for the patient.
• Review SA forms before submission to insurers.
• Proactively offer financial assistance to patients.
• Serve as a resource to physicians, nurses, patients and clinics.
• Contribute to data integrity and participate in education activities.
• Comply with Bayshore Policies and Quality Management System requirements.

Skills

Reimbursement navigation

Provincial/private coverage

Special Authorization process

PEPEDA confidentiality

Software proficiency

Independent work

Tools

Excel

Word

Outlook

Adobe Acrobat

CRM

VOIP

Web portals

Job description

Bayshore HealthCare in Mississauga is seeking a Reimbursement Specialist to support physicians and patients with drug coverage, navigate private and provincial plans, and ensure timely access to prescribed treatments. The role involves advocacy with insurers, maintaining patient records, and supporting renewals and coverage changes.

The ideal candidate has 2+ years in reimbursement navigation, strong software skills, and a good grasp of provincial/private criteria, PIPEDA, and health