The Reimbursement Specialist assumes responsibility for managing reimbursement related issues for patients requiring specialty medications. This role will act as the patient advocate and work closely with patients to navigate and secure potential sources of reimbursement. Together with the pharmacy services, this role will bring more convenience, lower spend, and better health outcomes to patients.
Determine operational processes, and lead internal and external teams in implementation of program launch and ongoing utilization through assigned and self-initiated “pull through” efforts.
Drive continual process improvements to enhance work efficiencies and optimize member experience. Provide training to internal team members as required.
Manage case-by-case reimbursement for patients requiring specialty medications. Gather all pertinent information, coordinate patient cases, manage applications and work directly with the private, public, or manufacturer-sponsored drug funding programs to optimize reimbursement.
Communicate and educate patients regarding their private drug coverage and options, including status of Prior Authorization requests.
Identify and resolve reimbursement issues to facilitate pharmacy processes including prescription processing and invoicing.
Identify gaps and opportunities for clinical education and healthcare support, and liaise with the appropriate internal teams or external organizations to provide and enhance patient care.
Maintain and manage standard operating procedures and specialty medication funding program database.
Develop and maintain relationships with private/public payers, manufacturers and plan sponsors. Apply knowledge and insights to enhance Specialty Pharmacy service offerings.
Bachelor’s Degree preferred
3-5 years of experience in the pharmacy benefit management, insurance, pharmacy, biotechnology, or pharmaceutical industries; customer service and/or reimbursement.
Demonstrated commitment to improve patient care
Able to work independently and within a team
Excellent written/verbal communication to include providing clear instructions
Ability to multitask
Strong problem-solving skills with the ability to resolve issues effectively and efficiently
Knowledge of the private or public drug reimbursement would be an asset
Knowledge of pharmacy dispensing software is preferred
Computer proficiency in MS Office applications, with database experience a plus
ABOUT EXPRESS SCRIPTS CANADA
Express Scripts Canada, a registered business name of ESI Canada, an Ontario partnership indirectly controlled by Express Scripts, Inc. (Nasdaq: ESRX), is one of Canada’s leading providers of health benefits management services. From its corporate headquarters in Mississauga, Ontario, just outside Toronto, Express Scripts Canada provides a full range of integrated pharmacy benefit management (PBM) services to insurers, third-party administrators, plan sponsors and the public sector, including health-claims adjudication and processing services, Home Delivery Pharmacy Services, benefit-design consultation, drug-utilization review, formulary management, and medical and drug-data analysis services, to better facilitate the best possible health outcomes at the lowest possible cost.
It will be a condition of employment that the successful candidate receives the Enhanced Reliability Clearance from the Federal Government. The candidate will be required to provide supporting documentation in order to receive Clearance if required.
We offer a competitive salary and benefits package, along with a positive work environment built on solid corporate values, integrity, mutual respect, collaboration, passion, service and alignment.
We are an equal opportunity employer that promotes a diverse, inclusive and accessible workplace. By embracing diversity, we build a more effective organization that empowers our employees to be the best that they can be.
We are committed to creating a working environment that is barrier-free and we are prepared to provide accommodation for people with disabilities.
Thank you for your interest in this position however, only qualified candidates will be contacted for an interview. No telephone calls please.