Medical Coding Research jobs

Gifthealth and Lily Canada Patient Support Program

*You would be hired as a Kelly Services employee, assigned to Gifthealth*

About Us

At Gifthealth, we're revolutionizing the way people experience healthcare by simplifying the process of managing prescriptions, patient support services, and medication access. Our mission is to provide a seamless, personalized, and efficient healthcare experience for patients, caregivers, healthcare providers, pharmacies, payers, and program partners. We're a dynamic, innovative, and customer-centric company dedicated to making a positive impact on people's lives.

Position Summary

The Bilingual (EN/FR) Drug Safety Specialist plays a critical, dual-purpose role at Gifthealth, serving as a frontline guardian for pharmacovigilance compliance while actively driving patient access and reimbursement workflows for the Lilly Canada Patient Support Program (PSP).

The primary focus of this non-clinical role is the vigilant identification, meticulous documentation, and rapid escalation of Adverse Events (AEs) and Product Complaints (PCs). Operating strictly within non-clinical boundaries, the Specialist ensures full compliance with manufacturer, client, and healthcare privacy standards. Concurrently, they act as a high-touch case manager—navigating complex Canadian public and private payer landscapes, resolving reimbursement barriers, and coordinating seamlessly with Healthcare Providers (HCPs), pharmacies, and patients to accelerate time-to-therapy.

Key Responsibilities

Core role: Compliance, Quality, Safety, and AE/PC Support

● Follow all applicable company policies, program requirements, client expectations, privacy requirements, and healthcare support standards.

● Maintain appropriate non-clinical role boundaries and escalate clinical, medication-specific, safety, or medical inquiry questions through the appropriate pathway.

● Support timely identification, documentation, and escalation of potential Adverse Events and Product Complaints in accordance with program-specific processes.

● Recognize patient, caregiver, HCP, pharmacy, or payer statements that may require AE/PC intake or escalation.

● Follow approved workflows to ensure AE/PC information is routed appropriately while maintaining non-clinical role boundaries.

● Document AE/PC-related activity accurately within the program system and escalate sensitive or urgent matters through the appropriate pathway.

● Prepare and/or assist with reports as requested, including adverse event and product complaint reports when applicable.

● Complete quality monitoring and quality assurance activities as assigned.

● Support audits, documentation reviews, workflow checks, and process improvement activities related to patient access and reimbursement support.

● Maintain accuracy, confidentiality, and professionalism when handling patient, HCP, pharmacy, payer, and program information.

Patient Access and Program Support

● Support patient access workflows for the assigned Lilly Canada Patient Support Program.

● Assist patients, caregivers, healthcare providers, pharmacies, and payers with moderate to complex access-related inquiries.

● Help identify and resolve access barriers related to insurance coverage, reimbursement requirements, missing documentation, HCP follow-up, pharmacy-related issues, or payer delays.

● Support patient enrollment, case review, coverage navigation, and program support workflows.

● Provide clear and professional support regarding program processes, access steps, reimbursement requirements, and case status.

● Review patient-specific eligibility for client patient support programs, financial assistance, or other access support services, as applicable.

● Reverify patient benefits at predetermined timeframes or as required by the program.

● Escalate complex access cases or unresolved barriers through the appropriate program pathway.

Reimbursement, Insurance, and Payer Support

● Complete benefit investigations and coverage reviews based on program requirements.

● Research and assess patient-specific insurance coverage options for assigned program products.

● Support payer outreach, reimbursement navigation, coverage verification, and insurance-related case follow-up.

● Support Special Authorization / prior authorization-related workflows, including payer follow-up and documentation review.

● Support appeal-related workflows when coverage or reimbursement barriers are identified.

● Review denied, delayed, or underpaid claims when applicable to the program workflow.

● Research public and private payer medical policies, coverage criteria, reimbursement requirements, and Special Authorization requirements.

● Monitor and update payer prior authorization requirements and coverage policies for assigned client program products.

● Identify trends related to payer denials, documentation gaps, coverage restrictions, appeal needs, or repeated access barriers.

HCP, Pharmacy, and Stakeholder Coordination

● Serve as a patient access resource for healthcare providers, HCP offices, pharmacies, payers, and other external stakeholders.

● Assist HCP offices with coverage, reimbursement, Special Authorization, documentation, and payer-related questions.

● Coordinate with pharmacies when pharmacy-related information, access barriers, or prescription support questions impact case progression.

● Interact with insurance payers to confirm coverage status, payer requirements, prior authorization criteria, reimbursement pathways, and policy updates.

● Manage patient cases and collaborate with external contacts, including payers, HCP offices, pharmacies, and other program stakeholders.

● Assist with coordination of relevant tasks and activities between Gifthealth, client program stakeholders, and external partners.

● Support escalated access or reimbursement cases requiring additional research, payer follow-up, or client/program review.

Case Management and Documentation

● Document all patient, payer, HCP, pharmacy, reimbursement, and access support activities in the program database within required timelines.

● Maintain accurate case notes, payer updates, follow-up dates, case status, and resolution details.

● Review case documentation to ensure required information is complete, accurate, and aligned with program expectations.

● Monitor assigned cases to ensure timely follow-up and appropriate case progression.

● Identify cases requiring escalation due to access barriers, payer delays, missing documentation, unresolved HCP follow-up, pharmacy-related issues, or program-specific exceptions.

● Support case reviews and help determine appropriate next steps based on payer requirements, program guidance, and documented case history.

● Assist with reporting needs related to case activity, reimbursement trends, payer barriers, access barriers, and program performance.

Client and Program Support

● Support communication and coordination with client contacts, program stakeholders, and internal Gifthealth teams.

● May serve as a program-specific access support contact for client or stakeholder inquiries.

● Provide patient access and reimbursement-related insight to internal teams based on payer trends, case barriers, and program needs.

● Participate in regular meetings with operations, quality, training, leadership, and program stakeholders to ensure alignment.

Qualifications

Education

● High school diploma or equivalent required.

● Completion of a relevant healthcare, pharmacy, reimbursement, patient access, hub services, or insurance training program preferred.

● Certified Pharmacy Technician, reimbursement certification, or healthcare access-related training preferred but not required.

Experience

● Health Canada experience is highly preffered

● Minimum of four years of recent healthcare experience required.

● Minimum of two years of direct patient access, reimbursement, hub services, payer support, pharmacy, or healthcare industry experience preferred.

● Experience supporting insurance benefit investigations, reimbursement navigation, prior authorization, Special Authorization, appeals, patient assistance programs, or payer policy research preferred.

● Experience working with patients, caregivers, HCP offices, pharmacies, payers, or program stakeholders preferred.

● Experience supporting specialty medication, chronic therapy, or complex access programs preferred.

● Client interaction experience preferred.

● High-volume healthcare support experience preferred.

Skills

● Bilingual French and English, is strongly preferred.

● Strong understanding of patient access workflows, benefit investigations, coverage review, payer follow-up, reimbursement navigation, prior authorization, appeals, and patient assistance support.

● Knowledge of medical insurance, public and commercial coverage, billing, coding, reimbursement terminology, and payer requirements.

● Advanced problem-solving, research, and analytical skills.

● Excellent customer service skills.

● Advanced written and verbal communication skills.

● Strong attention to detail and data entry accuracy.

● Ability to manage sensitive patient, provider, pharmacy, payer, and program information appropriately.

● Ability to multi-task, prioritize work, and manage time independently.

● Ability to navigate multiple systems while maintaining accuracy and productivity.

● Proficiency in Microsoft Office products, CRM platforms (Salesforce), case management systems, payer portals, and related technology.

● Ability to adapt to changing workflows, payer requirements, program updates, and client expectations.

Work Environment

● Location: Remote.

● Schedule: Full-time.

● May require availability or flexibility for escalations, program needs, client updates, or workflow support.

● Regular meetings with teams, departments, leadership, client contacts, and program stakeholders to ensure alignment.

● Work is performed in a healthcare operations environment where accuracy, confidentiality, documentation quality, timely follow-up, and patient experience are essential.

Pay: $62,000.00-$64,500.00 per year

Benefits:

• Dental care
• Paid time off
• Work from home

Experience:

• pharmaceutical industry: 3 years (preferred)
• Health Canada: 3 years (preferred)

Language:

• French (preferred)

Work Location: Remote