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Reimbursement Specialist

Reimbursement Specialist

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.

ESSENTIAL FUNCTIONS:

  • 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.

QUALIFICATIONS:

  • 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

Express Scripts Canada is a Cigna company

Express Scripts Canada is a subsidiary of Express Scripts, a Cigna company. Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, wellbeing and peace of mind of those we serve. Cigna offers an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioural health, pharmacy, vision, supplemental benefits, and other related products.

About Express Scripts Canada

Express Scripts Canada is a leading health benefits manager and has been recognized as one of the most innovative. Our clients include Canada’s leading insurers, third party administrators and governments. We work with these clients to develop industry-leading solutions to deliver superior healthcare in a cost-controlled environment. We provide Active Pharmacy™ services to more than 7 million Canadian patients and adjudicate more than 100 million pharmacy, dental, and extended health claims annually. Through our proprietary consumer intelligence, clinical expertise, and patients-first approach, we promote better health decisions for plan members, while managing and reducing drug benefit costs for plan sponsors.

It will be a condition of employment that the successful candidate obtains an Enhanced Reliability Clearance from the Federal Government. The candidate will be required to provide supporting documentation 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.

If you require accommodation in completing the online application process, please email: [email protected] Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response.

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