Job Description

ABOUT THE ROLE:

Offers reimbursement administrative support to Nurse Case Managers and program managers, while responding to general patient, pharmacy and physician inquiries and creating and following up on submissions pertaining to obtaining coverage through private and provincial drug plans

A DAY IN THE LIFE:

• Keeps detailed electronic charts of all interactions regarding patients.
• Provides reimbursement support to programs and nurse case managers
• Monitors the fax mailbox, distributes incoming communications, and uploads documents into electronic patient files.
• 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
• Performs general ad hoc requests for assistance including communicating with patients
• Participates in data integrity/file cleanup projects as required.
• Keep detailed notes in the patient\xe2\x80\x99s electronic chart
• Follow-up/advocate until a decision is received to secure coverage for the patient
• Completes and/or reviews Prior Authorization (PA) or Special Authorization (SA) forms prior to submission to insurers
• Assist with data integrity/rounds as required
• Communicates with patients regarding their third party insurance provider, or ODB, to resolved billing issues
• Communicates with patients\xe2\x80\x99 third party plans, or ODB, to troubleshoot rejected claims
• Assists the pharmacist in entering prescriptions into the prescription software (Kroll), and filling/billing such prescriptions
• Participate in ongoing internal and/or external continuing education activities
• Adhere to Bayshore Policies and Procedures
• Maintains relevant level of knowledge of, and adherence to, Health Canada GVP (Good Pharmacovigilance Practices) guidelines appropriate to the position.
• Maintains patient confidentiality in all communications, in accordance with relevant privacy legislation.
• Must be able to identify and report AE\xe2\x80\x99s to health Canada
• Maintains confidentiality of client and corporate information and discusses same only with appropriate Bayshore personnel
• Complete all other duties assigned

Bayshore is committed to a high quality and safe environment for both our staff and clients/patients. At Bayshore all new hires must have received the full series of a COVID-19 vaccine or combination of COVID-19 vaccines approved by Health Canada (e.g., two doses of a two dose vaccine series or one dose of a single- dose vaccine series); AND have received the final dose of the COVID-19 vaccine at least 14 days prior to the official start date of hire. Medical exemptions or any other kinds of requested exemptions based upon Human Rights Code will be considered on a case-by-case basis. Bayshore operates in accordance with the Accessibility for Ontarians with Disabilities Act, 2005 and applicable Provincial Human Rights Code.

Qualifications

WHAT YOU BRING TO THE TEAM:

• College diploma in administration, or equivalent experience.
• Basic understanding of patient support programs and reimbursement.
• Call Centre or customer service experience an asset.
• Strong computer and software skills: Excel, Word, Outlook, Adobe Acrobat, CRM database entry, VOIP telephony, web portals, teleconferences, web-based meetings.
• Bilingual (French) required

Bayshore HealthCare