Reimbursement Specialist

Bayshore HealthCare; Mississauga; On-site; CAD 50,000 - 70,000; Full time

Job summary

Bayshore HealthCare is seeking a Reimbursement Specialist to support physicians and patients in obtaining drug coverage. This role requires navigating public and private insurance landscapes, ensuring timely access to medications while advocating for patient needs and maintaining essential documentation.

Qualifications

• Minimum 2 years of reimbursement navigation experience.
• Understanding of insurance criteria and authorization processes.
• Familiarity with PIPEDA for patient confidentiality.

Responsibilities

• Gather information to complete insurance forms.
• Liaise with insurance providers for coverage.
• Advocate for patient coverage decisions.

Skills

Advocacy

Communication (English)

Computer Skills

Tools

Excel

Word

Outlook

Adobe Acrobat

CRM

VOIP

Web Portals

Job description

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Job Summary

Under the supervision of the 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 and advocate until a decision is received to secure coverage for the patient.
• Complete and/or review SA forms prior to submission to insurers.
• Proactively offer financial assistance for patients.
• Act as a resource for program stakeholders, including physicians, nurses, patients, clinics, and the client.
• Assist with data integrity and rounds as required.
• Participate in ongoing internal and 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.
• Maintain relevant knowledge of ICH, GCP, and Health Canada GVP guidelines, with regular updates provided.
• Identify and report adverse events to Health Canada, Med Info, and enter into source and third-party systems.
• Participate in processes related to regulatory reporting requirements.
• Participate in proactive Health & Safety activities and report risks or concerns to immediate supervisors.
• Maintain confidentiality of client and corporate information.
• Complete other tasks as requested.

Qualifications

• Familiarity with PEPEDA and its application in a confidential patient environment.
• Minimum 2 years of Canadian public and private reimbursement navigation and advocacy experience, preferably 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 skills: Excel, Word, Outlook, Adobe Acrobat, CRM, VOIP, web portals, teleconferences, web meetings.
• Ability to work independently, make decisions, and meet deadlines.
• Comfort working in a paperless environment.
• Excellent English communication skills; French is an asset.
• Knowledge of PIPEDA and its application in a confidential patient environment.

Additional Information

• Location: ON-Mississauga
• Seniority level: Entry level
• Employment type: Full-time
• Job function: Finance and Sales
• Industries: Hospitals and Health Care

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