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The Reimbursement Specialist coordinates and manages all aspects of obtaining prescription drug coverage for patients by working with insurance companies, physicians, and healthcare professionals. They are also responsible for implementing financial means tests, managing pharmacy processes, and reporting adverse events.
Ce poste s'inscrit dans le cadre des services d'accompagnement des patients et des professionnels de santé ainsi que des services de commercialisation pharmaceutique proposés par Cencora au Canada, par l'intermédiaire de notre division Innomar Strategies.
This role is in support of Cencora's patient and provider support and pharma commercialization services in Canada marketed through our Innomar Strategies business.
Responsabilités:
Coordonner et gérer tous les aspects requis afin d'obtenir la couverture de médicaments d'ordonnance pour les patients;
Coordonner les cas avec les compagnies d'assurance, les cabinets de médecins et les professionnels de la santé afin de maximiser les solutions de remboursement;
Coordonner les documents, les soumissions et tous les documents connexes aux compagnies d'assurance, programmes de financement public/fédéral;
Mettre en œuvre le test de moyens financiers tel que requis dans le but de maximiser la couverture des médicaments d'ordonnance du patient
Coordonner les processus de pharmacie requis lorsque le financement a été obtenu; et
Acquérir une connaissance approfondie des mécanismes de financement public/privé et fédéral.
Responsable de signaler tous les événements indésirables aux départements concernés.
Le/la spécialiste de remboursement sera également affecté(e) à d'autres fonctions et tâches au besoin de temps à autre.
Responsibilities:
Daily and ongoing communication with Program Manager / Associate Program Manager for new and existing projects;
Demonstrate in depth knowledge of rare disease program offerings, including the pathophysiology of the disease/product, therapeutic area, disease process, and mechanism of action; and how to apply rare disease SOPs;
Exhibit in depth knowledge of public/private and federal funding mechanisms as well as Rare Disease funding bodies (US and Canada).
Coordinate cases with physician and healthcare professionals in order to prepare submission meeting specific specifications/criteria set by public/private payers.
Coordinate and manage all aspects required in order to obtain prescription drug coverage for patients;
Coordinate cases with insurance companies, physician’s offices and healthcare professionals in order to maximize reimbursement solutions;
Navigate through the complex lobbying process to obtain prescription drug coverage and reimbursement for these life-saving and costly medications;
Coordinate documents, submissions and all related paperwork to insurance companies, public/federal funding programs;
Implement Financial Means Test as required in an effort to maximize patient’s prescription drug coverage
Coordinate pharmacy processes required once funding has been obtained;
Responsible to report all Adverse Events to the assigned units/departments;
The Reimbursement Specialist will also be assigned other duties and tasks as required from time to time.
Niveau d’éducation:
Éducation post-secondaire ou l'équivalent dans une discipline connexe;
Expérience:
Minimum de 2 ans d'expérience en service à la clientèle, dans un environnement de bureau;
Solide maîtrise des applications Microsoft (Outlook, Word, Excel);
Manières professionnelles/courtoises/efficaces au téléphone;
Capacité éprouvée à organiser le temps, fixer les priorités et à accomplir de multiples tâches afin de respecter les diverses échéances de travail concurrentes;
Le candidat doit avoir de solides compétences en communication et en relations interpersonnelles;
Capacité à travailler de façon autonome et dans un environnement d'équipe;
Souci du détail;
Expérience dans l'industrie des soins de santé, des produits pharmaceutiques ou de l'assurance est un atout; et
Le bilinguisme, français/anglais est requis.
Compétences et Connaissances:
Connaissance avancée de l'industrie de la distribution pharmaceutique
Connaissance pratique du système automatisé d'opération d'entrepôt
Solide sens des affaires et sens financier
Compétences analytiques et mathématiques solides
Capacité à communiquer efficacement oralement et par écrit
Compétences interpersonnelles et de leadership efficaces
Sens de l'organisation; souci du détail
Capacité à respecter systématiquement les échéances
Excellentes aptitudes de résolution de problèmes; Capacité éprouvée à résoudre les problèmes avec efficacité et efficience
Excellentes aptitudes de présentation
Connaissance de Microsoft Word, Excel, PowerPoint et d'autres programmes Office
Work Experience:
Minimum of 3 years’ experience in the pharmaceutical, insurance or healthcare-related industries;
Previous experience in reimbursement and Knowledge of public, private and federal reimbursement is required;
Minimum of three (3) years’ experience in a Customer Service setting; OR Five (5) years or more tenure as a Sr. Reimbursement Specialist
Professional / courteous / efficient telephone manner;
Strong proficiency in Microsoft applications (Outlook, Word, Excel);
Proven ability to organize time, set priorities and multi-task in order to meet various competing work deadlines;
Candidate must have strong communication and interpersonal skills, including the ability to communicate with patients in a healthcare setting on extremely sensitive topics;
Ability to work independently and in a team environment;
Attention to detail; and
Bilingualism, French/English is required.
Skills and Knowledge:
Advanced knowledge of pharmaceutical, or insurance industry
Strong business and financial acumen
Strong analytical and mathematical skills
Ability to communicate effectively both orally and in writing
Effective interpersonal and leadership skills
Effective organizational skills; attention to detail
Ability to consistently meet deadlines
Excellent problem-solving skills; ability to resolve issues effectively and efficiently
The successful candidate may have daily contacts with unilingual English-speaking customers, patients or peers from cross-functional teams.
Cencora is committed to fair and accessible employment practices. When requested, Cencora will accommodate people with disabilities during the recruitment, assessment and hiring processes and during employment.
Cencora is committed to providing equal employment opportunity without regard to race, color, religion, sex, sexual orientation, gender identity, genetic information, national origin, age, disability, veteran status or membership in any other class protected by federal, state or local law.
The company’s continued success depends on the full and effective utilization of qualified individuals. Therefore, harassment is prohibited and all matters related to recruiting, training, compensation, benefits, promotions and transfers comply with equal opportunity principles and are non-discriminatory.
Cencora is committed to providing reasonable accommodations to individuals with disabilities during the employment process which are consistent with legal requirements. If you wish to request an accommodation while seeking employment, please call 888.692.2272 or email hrsc@cencora.com. We will make accommodation determinations on a request-by-request basis. Messages and emails regarding anything other than accommodations requests will not be returned
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