Medical Adjudication jobs in Ontario

Job Overview
Pharmacy.ca (Central Medical Pharmacy Inc.) is comprised of a team that is passionate about providing personalized medicine, ensuring patients maximize the therapeutic benefits of the medications they are prescribed and minimize undesirable side effects. We are looking to add a permanent full-time Customer Service Representative/Program Coordinator, Drug Reimbursement with experience in, or a strong interest in, coordinating the drug reimbursement process for patients seeking coverage for their prescribed medications.

If you are passionate about providing excellent customer service this could be the role for you! We provide our patients with the best possible care in a customer-oriented manner. This is a Fulltime, M-F, 9 AM - 5 PM role located in midtown Toronto, near DVP and Eglinton.

Responsibilities:

• Process and complete insurance billing for medical claims
• Interview patients on prior medical health for data records and insurance form completions
• Collect supportive information for special authorization requests through handling patient/physician calls and inquiries.
• Records and maintains confidential patient information and treatment details
• Complete insurance prior authorization forms and drafts supporting documents for patients’ drug reimbursement needs
• Review, analyze, and validate information provided by patients and medical offices for accuracy and completeness to provide service in an efficient manner.
• Identify and assess patient and physician needs to achieve satisfaction with tact, patience and politeness
• Handle confidential/sensitive information with discretion and maturity
• Coordinate program activities and liaise directly with clinics, healthcare providers and insurance companies to enhance the delivery of program services.
• Assist healthcare providers in completing prior authorization documents for drug reimbursement
• Manage multiple accounts and foster customer loyalty by providing outstanding service.
• Answer patient inquiries and provide information about drug reimbursement policies, procedures, and requirements
• Investigate and resolve customer complaints related to drug reimbursement issues
• Stay up to date on industry trends and changes in drug reimbursement policies and regulations
• Insurance case management; Investigate status of prior authorization submission and coverage details with insurance companies
• Place order requests to ship medications to clinics and investigate logistics related errors and complaints
• Act as account representative for assigned accounts under the specialty program by managing client relationship, addressing their concerns, providing exemplary customer service and providing relevant account insights to Program Manager.
• Perform other duties as assigned by the manager or supervisor

What You’ll Bring to the Team

• College Diploma, University Degree, or equivalent experience
• 1–3 years of experience in a customer-facing role
• Prior experience in reimbursement support or Patient Support Programs (PSP) is an asset
• Experience with prescription filling and billing, including troubleshooting third-party insurance adjudication issues, is an asset
• Strong customer service focus with a commitment to providing high-quality patient care
• Ability to take ownership and ensure patient reimbursement issues are resolved in a timely manner
• Excellent organizational skills and high attention to detail
• Strong problem-solving abilities and critical thinking skills
• Effective verbal and written communication skills
• Ability to work independently and collaboratively within a team environment
• Strong time management and multitasking abilities, with the ability to prioritize tasks effectively
• High level of professionalism with a strong understanding of patient confidentiality requirements
• A genuine desire to help patients and contribute positively to the team

Job Reference Number: 60621

We are located near the Science Center & DVP and will preferentially consider candidates with shorter commute times. This role is 100% in office.

Job Types: Full-time, Permanent

Pay: From $21.00 per hour

Application question(s):

• What are the first three characters of your postal code?
• Please state the reference number listed in the job application.

Work Location: In person