Job Summary
To be a single point of contact offering reimbursement support to physicians and medical case management services to patients. Assist the physician with the completion of all program-specific paperwork and follow-up on submissions pertaining to obtaining drug reimbursement/coverage through private and provincial drug formularies to ensure patients have access to their prescribed treatments in a timely manner. Act as a resource to physicians who are prescribing this medication and continuous support for patients for on-going support, renewals, and coverage changes. This position reports into the Program Manager.
Duties And Responsibilities
- Assist in completing patient enrolment, including gathering all pertinent and appropriate information to complete the necessary forms (private and/or provincial insurance) in a concise, organized, and professional manner.
- Introduce the Program to patient, explain Program offerings and support services available, to ensure that patient and/or caregiver is comfortable with the Program offerings
- Confirm and/or obtain personal, health and applicable demographic information of the patient, including patient gender, date of birth, address, telephone number, email address, for the purposes
of providing patient support of the Product
- Collect heath information needed to secure reimbursement coverage and provide patient support of the Product
- Collect insurance coverage and related information pertaining to the patient’s plan
- Collect pharmacy information in addition, the SPOC will explain that bridging medication will be provided to the patient, or copay support, and the prescription will be transferred to the patient’s preferred pharmacy if they request until they have coverage through either a private or public plan or until Program termination date and/or GSK instructs Bridging coverage is terminated
- Contact patient to advise on payer decision as it relates to drug coverage and advise on next steps as applicable
- Ensure that the physician is aware of the reimbursement outcome of the patient, proactively, within 2 business days of a decision unless otherwise requested by the physician
- Arrange for drug shipment, when required, within 2 business days of reimbursement navigation
- Liaise and advocate with third-party providers and provincial governments as necessary to determine coverage options.
- Ensure patients are scheduled for necessary diagnostic tests and notify physicians of any expired test results that require follow-ups.
- Complete Welcome Call activities with the patient according to defined scripts.
- Provide patients and physicians with direct toll-free number.
- Review post visit reports to confirm next appointment is scheduled and data integrity of the report against the physician order, if applicable.
- Track missing post visit reports, if applicable.
- Facilitate any required communication with physicians, Patient Support Programs, or other health care professionals involved in the patient’s circle of care.
- Follow up and advocate until a decision is received, ideally securing coverage for the patient, if applicable.
- Work closely with the manufacturer local sales representatives to support specific physician’s and staff needs, if applicable.
- Offer and/or provide educational training to patients and physicians on product(s).
- Act as a central resource liaison for program stakeholders, which include physicians, nurses, patients, and clinics.
- Coordinate and schedule patients at appropriate visit locations (home, clinic, etc.), if applicable.
- Provide updates to internal and external stakeholders based on observations.
- Ensure patient records are maintained and data-accurate to meet program reporting requirements.
- Must be able to identify and report Adverse Events to Health Canada, Med Info, and enter into source system and third-party systems.
- Report and document Adverse Events as per Pharmacovigilance requirements.
- Participate in quality activities and continuous improvement initiatives in keeping with the company’s Quality Management System as well as specific performance indicators for the project.
- Maintain confidentiality of pharmaceutical partner(s) and corporate information and discuss same only with appropriate Bayshore personnel.
- Complete all relevant reports (time sheets, expenses, mileage, reports, etc.) as per specified timelines and Bayshore’s policy, if applicable.
- Complete product complaint reports.
- Adhere to Bayshore and manufacturer Policies and Procedures.
- Complete other tasks, as requested.
Qualifications
- Graduate of Registered Nursing Program or Registered/Licensed Practical Nursing program holding current registration from a provincial licensing body in Canada.
- Registered and in good standing with their provincial regulatory body.
- Minimum 2 years’ experience in Patient Support Programs or equivalent.
- Demonstrated expertise in delivering exceptional customer service and fostering positive relationships with internal and external stakeholders.
- Understanding of provincial and private coverage criteria, Special Authorization processes and how to navigate the Canadian drug coverage landscape is an asset.
- Strong computer and technical skills: Excel, Word, Outlook, tablets, web portals/internet use.
- Strong critical thinking and problem-solving skills.
- Making decisions using sound judgment.
- Proficient with accurate data collection and data integrity.
- Ease with working in a paperless environment.
- Ability to drive for results.
- Proven ability to work in a team environment.
- Ability to resolve conflict in a professional matter.
- Strong sense of organization and attention to detail.
- Self-regulation of time management and the ability to multi-task and adhere to deadlines.
- Familiarity with PIPEDA and how it applies in a confidential patient environment.
- Ability to work in a quiet working environment with proven ability to work autonomously within a remote/virtual team environment.
- Established high speed internet access from home office.
Primary Location
Ontario