Job Details

• Liaise with the patient, insurer and physician regarding the documentation required for maximum reimbursement coverage, including the exploration of all public and private insurers and providing employer escalations as required

• Responsible for escalation management in cases where assistance beyond program scope is required

• Gather all pertinent and appropriate information from the patient chart and complete necessary documents in a concise, organized and professional manner and submit physician signed forms to the private and/or provincial drug benefit insurer/agency

• Follow up with applicable insurers until a decision is received, with the intent of expediting a decision where possible. If the submission has been denied, the Senior Patient Services Specialist will discuss this with the physician and resubmit if agreed upon

• Updates with respect to the reimbursement submissions, confirmation of coverage and re-submissions will be entered into the patient database

• Complete follow ups with patients on behalf of the physician offices, as required, to ensure adherence to treatment regimens

• Provides information and updates to physicians and staff in their offices regarding the medication in terms of new criteria and indications as received from McKesson Canada or the Client

• Receive, record and report Adverse Events as per the Pharmaceutical Manufacturer requirements

• Participate and assist in departmental continuous improvement activities related to process, quality, training etc.

• Maintain service levels in case management, including Adverse Events reported within twenty-four hours of receipt and any other Key Performance Indicators established at the Program level

• Perform data-entry, answer inbound calls, make outbound calls, manage e-mail and fax software, general administrative functions including faxing, filing, scanning.

Minimum Requirements:

• Typically requires 5+ years of related experience.

Competencies:

• Excellent verbal and written skills in English (and French if a Bilingual role)

• Flexibility in working rotational or variety of different hours (hours of operation are 8 am to 8 pm Monday to Friday)

• Strong customer service, communication, problem solving skills required

• Proficient in Microsoft Office applications (Word/Excel)

• Team Player and comfortable working independently

• Thorough knowledge of adult learning principles and training.

• Organized with a high attention to detail

• Understands and applies techniques to manage multiple priorities

• Possesses a high level of motivation to achieve necessary involvement within a team