We are growing! We are seeking a highly skilled and detail-oriented Reimbursement Specialist to join our team. The ideal candidate will have extensive experience navigating the complex landscape of private and public insurance coverage systems within Ontario, Canada, with a strong emphasis on specialized therapeutic areas. This role is critical in helping patients access essential, advanced treatments by managing the end-to-end reimbursement process efficiently and accurately.
Key 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.
Required Qualifications & Skills:
- Disease State Knowledge: Strong foundational knowledge of complex disease states, including inflammatory bowel disease, rheumatological diseases, dermatological diseases, and autoimmune conditions.
- 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.
- Communication: Excellent verbal and written communication skills, with a patient-first approach.
- Attributes: Highly organized, detail-oriented, self-motivated, and capable of managing a high volume of complex cases independently.
Job Type: Full-time
Pay: $48,000.00-$55,000.00 per year
Benefits:
Ability to commute/relocate:
- Hamilton, ON: reliably commute or plan to relocate before starting work (required)
Application question(s):
Demonstrated working knowledge and proficiency with the TELUS Kroll system Proficiency using QHR Accuro EMR system ideal
Experience:
- healthcare administration and reimbursement specialization : 1 year (required)
- Advanced Therapeutic Medication: 1 year (preferred)
Location:
Work Location: In person
