POSITION SUMMARY:
Reporting to the Manager, the Reimbursement Team Lead will be primarily responsible for overseeing a team of reimbursement associates dedicated to navigating the reimbursement landscape specific to biologic medications. Your role will include ensuring precise and prompt processing of claims, optimizing reimbursement, and facilitating patient access to specialty pharmacy services.
PRIMARY DUTIES AND RESPONSIBILITIES:
- Communicate with patients, prescribers, healthcare professionals and other key players to support patients through their treatment journey.
- Verify and investigate insurance coverage and benefits for patients, including eligibility, co-payments, deductibles and prior authorizations.
- Maintain confidentiality of patient healthcare information.
- Liase with private and public insurance providers to determine coverage options
- Act as a central liaison for stakeholders such as physicians, nurses, patients, and clinics and provide required updates.
- Supervise and mentor a team of reimbursement associates focused on biologic medications.
- Keep up to date with changes in insurance coverage and reimbursement policies and communicate these changes to healthcare providers and patients.
- Provide patient education based on protocols, individually or in groups.
- Provide guidance, training, and support to ensure adherence to departmental goals and performance metrics.
- Conduct weekly audits for team’s files.
- The Reimbursement Associate will also be assigned other duties and tasks as required from time to time.
QUALIFICATIONS AND SKILLS:
- A college diploma or higher in a healthcare related course is an asset
- Two or more years of reimbursement navigation experience involving private and public payers is required.
- Two or more years of related pharmacy experience is an asset
- Experience working with Patient Support Programs is an asset
- Experience with Kroll Pharmacy Management System is an asset
- Familiarity with the Special Authorization process for both public and private insurance in assigned territory
- Proficiency in Microsoft Office Applications (Outlook, Word, Excel)
- A demonstrated commitment to high professional ethical standards and a diverse workplace
- Proven ability to work in a team environment and independently
- Ease with working in a paperless environment
- Time management skills and the ability to multi-task and adhere to deadlines.
Number of positions: 1
Vacancy Type: Replacement
At Rx Connect, we may leverage AI-powered tools in our recruitment process. AI will never reach out to our candidates directly.
Rx Connect operates in accordance with the Accessibility for Ontarians with Disabilities Act and applicable Provincial Human Rights Codes.
If you require accommodation in the interview process, please let us know.
Thank you for your interest in a career with Rx Connect. We appreciate all applications; however, only candidates whose experience and qualifications closely match the job requirements will be contacted.
Job Types: Full-time, Permanent
Pay: $58,000.00-$63,000.00 per year
Benefits:
- Casual dress
- Company events
- Dental care
- Extended health care
- Life insurance
- On-site parking
- Paid time off
- Vision care
- Work from home
Application question(s):
- Walk us through your process for obtaining reimbursement approval for a complex biologic medication requiring prior authorization.
- How do you balance payer requirements, patient needs, and physician expectations when managing reimbursement cases?
- How do you ensure your reimbursement team consistently meets approval, turnaround time, and patient access targets?
- Tell us about a process improvement you implemented that increased reimbursement success rates or reduced approval timelines.
Work Location: In person
