Job Description

ABOUT THIS ROLE
Under the supervision of the Reimbursement Associate Program Manager, the Bilingual 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. Please note that this role is completely remote and the individual can be based anywhere in Canada. 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 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 ICH (International Conference on Harmonization), GCP (Good Clinical Practice), and Health Canada GVP (Good Pharmacovigilance Practices) guidelines appropriate to their hired role which is to be provided at 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 info 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 injury them on the job within 24 hours of the incident
• Maintain confidentiality of client and corporate information and discussion same only with appropriate Bayshore personnel
• Complete other tasks as requested
  

• 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
• Excellent written and verbal communication skills in English and French is required
• Understanding of provincial and private coverage criteria
• 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 judgement, and meeting deadlines
• Ease with working in a paperless environment
• Familiarity with PIPEDA and how it applies in a confidential patient environment