About this role
Full job description
At *Charlton*, you will work within a culture dedicated to providing exceptional patient care. We put the patient at the centre of everything we do. As a *leader in the complete management of advanced therapeutic specialty medications, The Charlton Centre for Specialized Treatment *along with our *pharmacy partner Charlton Health* are expanding our services for patients and prescribers! We seek an additional *Reimbursement Specialist to join our team. This individual,* in affiliation with Charlton's partner support programs, will be responsible for the coordination and ongoing delivery of services to make certain that our *patients have access to specialty medications in a timely manner.* The role involves liaising with patients, insurance companies, pharmacists, pharmacy coordinators, physician specialists and other healthcare professionals, ensuring the highest level of professional service. The successful candidate will be a patient advocate, working closely with them and their prescriber's practice to navigate and secure all potential sources of reimbursement.
*PRIMARY DUTIES AND RESPONSIBILITIES*:
- *Case Management:* Manage patient cases requiring coverage for advanced therapeutic treatments, specifically biologics and biosimilars, within the inflammatory bowel disease, rheumatological, dermatological, and general autoimmune condition domains.
- *System Navigation:* Utilize expertise in healthcare administration software, specifically the *TELUS Kroll system* and the *QHR Accuro EMR system*, to process claims, verify coverage, and manage patient records efficiently.
- *Insurance Expertise:* Act as the primary liaison between patients, healthcare providers, and insurance carriers (both public and private systems in Ontario) to secure coverage approvals and resolve claim denials.
- *Documentation & Compliance:* Ensure all documentation, prior authorizations, and appeals are accurate, complete, and submitted in compliance with provincial and federal regulations.
- *Patient Advocacy:* Provide empathetic support and clear communication to patients regarding their coverage options, potential costs, and the status of their reimbursement claims.
- *Knowledge Sharing:* Stay current with changes in Ontario's drug coverage policies (e.g., ODB, private payer formularies) and specialized treatment protocols to proactively address access barriers
*QUALIFICATIONS: *The successful candidate should have a minimum of:
- 2 years of experience in pharmacy benefit management, insurance, pharmacy, biotechnology, or pharmaceutical industries; customer service and/or reimbursement;
- *Treatment Knowledge:* Familiarity with advanced therapeutic treatments, including the reimbursement landscape for *biologics and biosimilars*.
- *Insurance Acumen:* In-depth understanding of the interplay between private insurance plans and public drug coverage programs (e.g., ODB, Trillium Drug Program) in Ontario.
- Demonstrated commitment to improve patient care;
- Able to work independently and within a team;
- Excellent written/verbal communication providing clear instructions;
- Excellent multitasking, organizational and time management skills, including attention to detail and ability to set priorities
- Strong problem-solving skills with the ability to resolve issues effectively and efficiently;
- Knowledge of the private and/or public drug reimbursement
- Knowledge of pharmacy dispensing software (*Telus Kroll*) is preferred
- Familiarity with EMRs (*QHR Accuro EMR*)
Pay: $50,000.00-$75,000.00 per year
Benefits
- On-site parking
Work Location: In person