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    Disability Claims Specialist - Toronto, ON, Canada - Bayshore HealthCare

    Bayshore HealthCare
    Bayshore HealthCare Toronto, ON, Canada

    1 week ago

    Bayshore HealthCare background
    Description

    Bayshore HealthCare is one of the country's leading providers of home and community health care services and is a Canadian owned company.

    Bayshore HealthCare is proud to showcase its achievement as a Platinum member of Canada's Best Managed Companies Program every year since 2006.

    Bayshore Healthcare is also Canada's Best Employers Forbes 2023 list. Bayshore Specialty Rx is a division of Bayshore HealthCare.


    Under the supervision of the Associate Program Manager, the Reimbursement/Client Care Specialist (CCS) will play an essential role in supporting patients living with a respiratory disease to improve both their health outcomes and quality of life.

    CCS will provide drug coverage support to physicians and patients, follow up on submissions pertaining to obtaining coverage through private and provincial drug plans, ensure patients have access to their prescribed treatments in a timely manner, act as a resource to physicians who are prescribing this medication, and provide continuous support for patients for renewals, and coverage changes.

    Gather all pertinent and appropriate information from the chart to complete the necessary forms (private and/or provincial insurance) in a concise, organized, and professional manner
    Coordinate and schedule patients at appropriate injection location (home, clinic, etc.)
    Act as a resource for program stakeholders, which include physicians, nurses, patients, clinics, and the client
    Assist with data integrity/rounds as required
    Communicate with patients regarding their third-party insurance provider, or public coverage provider, to resolved billing issues
    Communicate with patients' third-party plans, or public coverage provider, to troubleshoot rejected claims
    Assist the pharmacist in entering prescriptions into the prescription software (Kroll), and filling/billing such prescriptions
    Adhere to Bayshore Policies and Procedures
    Participate in quality activities and continuous improvement initiatives in keeping with the company's Quality Management System
    Is responsible to notify immediate supervisor of any Health & Safety risks or concerns.
    Maintain confidentiality of client and corporate information and discusses same only with appropriate Bayshore personnel
    Minimum 2 years of Canadian public and private reimbursement navigation and advocacy experience, within a patient program environment, ideally with PA/SA drugs for chronic disease

    • Understanding of provincial and private coverage criteria
    Familiarity with the Special Authorization process for both public and private insurance
    Strong computer and software skills: Excel, Word, Outlook, Adobe Acrobat, CRM database entry, VOIP telephony, web portals, teleconferences, web-based meetings, Kroll and/or other pharmacy-related software systems
    Excellent written and verbal communication skills in English
    Bilingual candidates considered an asset
    "At Bayshore Healthcare, our commitment to Equity, Diversity & Inclusion is our strength. This is how we bring our vision of being the difference in the lives of those we care for, work with and in our communities. We have a great sense of pride in creating a culture of belonging, where individual differences are embraced and celebrated, through programs, resources and policies that support each individuals purpose, potential and wellbeing."

    Bayshore operates in accordance with the Accessibility for Ontarians with Disabilities Act, and applicable Provincial Human Rights Codes. #
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