Reimbursement Specialist

POSITION Reimbursement Specialist
COMPANY AND LOCATION Specialty Pharma Solutions (Oshawa)
EMPLOYMENT TYPE Permanent, Full-time
HOURS WORKED Monday to Friday, 9 am to 5 pm
POSITION SUMMARY:
The Reimbursement Specialist is responsible for assisting in the navigation of public and private insurance providers to determine coverage options for medication therapy. Additional responsibilities include providing support for all dispensing related activities in the pharmacy including but not limited to, answering phone calls, processing prescriptions, scheduling deliveries, labelling, and collecting payments. This specialty pharmacy is closed to the public; medications are sent directly to patients or medical clinics. We are looking for a candidate who is reliable, organized, and works with a sense of urgency. The successful candidate should also possess excellent communication skills and a passion for delivering superior customer service. Preference will be given to candidates who are proficient with Kroll PMS and have experience troubleshooting adjudication issues with public and private insurers.

GENERAL RESPONSIBILITIES & ESSENTIAL FUNCTIONS:

• Maintaining patient files, including accurate entry of patient care information including allergies and medical conditions
• Accurate data entry of prescriptions into Kroll and filling/billing such prescriptions
• Communicate with patients, prescribers, healthcare professionals and other key stakeholders to support patients throughout their treatment journey
• Maintain confidentiality of patient healthcare information at all times
• Investigate and support the reimbursement process for insurance coverage and benefits for patients, including eligibility, co-payments, deductibles, and special/prior authorizations
• Liaise with public/private insurers and patient assistance programs to determine coverage options for patients
• Scheduling of medication deliveries with patients
• Maintaining prescription and OTC drug inventory, including completing inventory counts, checking expiry dates and placing drug orders
• Maintain a clean and organized dispensary

QUALIFICATIONS

• Experience with Kroll Pharmacy Management Software (preferred)
• Excellent Knowledge of MS Word, Excel and G Suite
• Excellent customer service skills
• High level of professionalism
• Strong written, verbal, and computer skills are required
• Self-motivated with strong work ethic
• Deadline-oriented and strong prioritization skills a must
• Experience with patient support programs and/or special authorization process (asset)

EDUCATION

• Highschool diploma or equivalent
• Completion of post-secondary education an asset

WORKING CONDITIONS:

• Office setting
• Fast-paced, busy work environment
• Manual dexterity to complete computer work

DISCLAIMER
The job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.

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