Bilingual Reimbursment Specialist - Québec, QC
Job Type: Full-time
Employment Status: Permanent
Years of Experience: 2
Number of Positions: 1
Contact Email: firstname.lastname@example.org
Bayshore is an Equal Opportuity Employer. We encourage all candidates who have the right mix of skills, abilities and a passion for excellence to apply.
Bayshore HealthCare is one of the country's leading providers of home and community health care services and a Canadian-owned company. Its services are purchased by government care programs, insurance companies, workers' compensation boards, health care organizations, the corporate sector and the public. The Bayshore brand extends across four business divisions: Bayshore Home Health (medical and non-medical home care and staffing services), Bayshore Specialty Rx (specialty pharmacy, infusion and pharmaceutical patient support services), Bayshore Therapy & Rehab (physiotherapy and rehabilitation services) and Bayshore Dialysis (dialysis centers). The company's goal is to enhance the quality of life, well-being, dignity and independence of Canadians of all ages. Bayshore HealthCare has been a recipient of Canada's 50 Best Managed Companies award since 2006.
Under the supervision of the 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.
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 on Harmonization), GCP (Good Clinical Practice) and Health Canada GVP (Good Pharmocovigilance 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 AE’s 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
- 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.
- Understanding of provincial and private coverage criteria
- Familiarity with the Special Authorization process for both public and private insurance in Quebec.
- Strong computer and software skills: Excel, Word, Outlook, Adobe Acrobat, CRM database entry, VOIP telephony, web portals, teleconferences, web-based meetings.
- Excellent written and verbal communication skills in English and French for positions requiring French
- Familiarity with PIPEDA and how it applies in a confidential patient environment.
- High school Diploma
- Ease with working independently, “playing detective,” making decisions using sound judgment, and meeting deadlines.
- Ease with working in a paperless environment.
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