Reimbursement Specialist

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

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.
• Must be able to identify and report AEs to Health Canada, Med Info and enter into source system and third-party systems.
• 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.
• Ensure timely and compliant reporting of Adverse Events (AEs) and Product Quality Complaints (PQCs) in accordance with Health Canada pharmacovigilance requirements and guidelines, including accurate documentation, appropriate escalation, and effective collaboration with internal stakeholders and regulatory teams.
• 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 individuals 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.

Primary Location

ON-Mississauga