Reimbursement Specialist - Express Scripts Canada

The Reimbursement Specialist assumes responsibility for managing reimbursement related issues for patients requiring specialty medications. This role will act as the patient advocate and work closely with patients to navigate and secure potential sources of reimbursement. Together with the pharmacy services, this role will bring more convenience, lower spend, and better health outcomes to patients.

ESSENTIAL FUNCTIONS:

• Determine operational processes, and lead internal and external teams in implementation of program launch and ongoing utilization through assigned and self-initiated “pull through” efforts.

• Drive continual process improvements to enhance work efficiencies and optimize member experience. Provide training to internal team members as required.

• Manage case-by-case reimbursement for patients requiring specialty medications. Gather all pertinent information, coordinate patient cases, manage applications and work directly with the private, public, or manufacturer-sponsored drug funding programs to optimize reimbursement.

• Communicate and educate patients regarding their private drug coverage and options, including status of Prior Authorization requests.

• Identify and resolve reimbursement issues to facilitate pharmacy processes including prescription processing and invoicing.

• Identify gaps and opportunities for clinical education and healthcare support, and liaise with the appropriate internal teams or external organizations to provide and enhance patient care.

• Maintain and manage standard operating procedures and specialty medication funding program database.

• Develop and maintain relationships with private/public payers, manufacturers and plan sponsors. Apply knowledge and insights to enhance Specialty Pharmacy service offerings.

QUALIFICATIONS:

• Bachelor’s Degree preferred

• 3-5 years of experience in the pharmacy benefit management, insurance, pharmacy, biotechnology, or pharmaceutical industries; customer service and/or reimbursement.

• Demonstrated commitment to improve patient care

• Able to work independently and within a team

• Excellent written/verbal communication to include providing clear instructions

• Ability to multitask

• Strong problem-solving skills with the ability to resolve issues effectively and efficiently

• Knowledge of the private or public drug reimbursement would be an asset

• Knowledge of pharmacy dispensing software is preferred.

• Computer proficiency in MS Office applications, with database experience a plus.

• Bilingual is an asset.