Full

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
- Solid 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

📌 Reimbursement Specialist (Canada)
🏢 Charlton Health Group
📍 Canada