Bilingual Document Specialist supporting a positive customer experience in Group Benefits Administration at Sun Life by processing documents and managing inquiries.
About the role
- Bilingual Case Manager managing patient enrollment and reimbursement processes for a pharmaceutical support provider in Canada. Collaborating with patients, insurers, and physicians to facilitate access to treatment.
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.
Requirements
- A Bachelor’s degree
- 2-3 years of experience in Patient Support Program
- Bilingualism (English and French) is required
- 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
- Employee & Family Assistance Program
- RRSP Matching Program
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