Bilingual Case Manager managing enrollment and monitoring reimbursement processes for patients at Sentrex Health Solutions. Ensuring timely access to prescribed therapies through effective support and coordination.
Responsibilities
Responsible for the timely enrollment of the patient into the Patient Support Program.
Collaborate with the patient, insurer and physician regarding the documentation necessary for maximal reimbursement coverage, including the investigation of all public and private insurers and supporting employer escalations as required.
Reviews patient status and assists the prescribing physician to prepare documentation for public or private coverage by reviewing patient charts, assessing previous therapies and tests.
Provides therapy guidelines/education on the program to manage patient and physician expectations.
Collects information and conducts patient financial assessment eligibility based on program guidelines.
Ensures patient services are coordinated and tracked in a timely manner resulting in quick and continued access to therapy.
Reports Adverse Events / Severe Adverse Events (AE / SAEs) following approved SOPs.
Maintain service levels in case management, including telephone answer rates, time to initial contact with the patient, Adverse Events reported within twenty-four hours of receipt and any other KPIs established as the Program level.
Electronically updates the Customer Relationship Management (CRM) tool by providing timely patient and clinic information.
Fosters and promotes a spirit of teamwork while working with internal patient support teams.
Acts a liaison and provides ongoing feedback to the Program Manager based-on observations in the field and feedback from customers as it pertains to quality of services, training, and other areas of importance.
Identifies obstacles to obtaining coverage and channels this information to the Program Manager and/or Assistant Program Manager.
Completes all relevant reports (time sheets, expenses, mileage, validate CRM reports, etc.) as per specified timelines and as per required standards.
Additional duties as requested by the Manager.
Requirements
A Bachelor’s degree in relevant field, or equivalent experience is required
Bilingualism (English and French) is required
Previous Patient Support Program Management experience preferred. Will consider candidates with insurance/benefits management experience
Strong operations experience required with a proven track record of success managing multiple priorities.
3 years of pharmaceutical industry experience with significant experience in the Ophthalmology therapeutic areas is preferred.
Experience with reimbursement billing, special access, the appeals process, and conducting field-based reimbursement support and consultation is an asset
Knowledge of private and public reimbursement structure, systems, and the process is an asset
Advanced knowledge of the pharmaceutical distribution industry
Must be able to work from home and have a quiet, private home office space
Strong analytical skills including interpretation of regulation and legislation
Excellent customer service, problem-solving, and conflict resolution skills
Effective interpersonal skills
Typing skills and ability to be a strong functional user of various computer-based programs
Benefits
Competitive Salary and generous vacation entitlement
Wellness Program (5 paid days off for your well-being!)
Paid Sick Days
Competitive Benefits Package including Dental & Extended Health Benefits, AD&D, LTD & Employee/Dependent Life Insurance
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