Responsable - Accès patients, réclamations et aide financière / Manager - Patient Access, Claims and Financial Assistance

Sentrex Health Solutions•Quebec, QC

58d•Hybrid

About The Position

Sentrex Health Solutions is a fully integrated specialty distributor and patient support provider for pharmaceutical manufacturers, physicians, and their patients. We provide innovative solutions focused on ensuring patients have access and the support they need to maximize their treatment outcomes. This position is for our affiliated partner pharmacy, Raji Al-Kurdi Pharmacien Inc. The successful candidate will be hired by Raji Al-Kurdi Pharmacien Inc. The Manager - Patient Access, Claims and Financial Assistance is responsible for coordinating the full access-to-treatment cycle for specialty medications, including insurance coverage validation, prior authorization follow-up, patient financial assistance management, manufacturer and Patient Support Program (PSP) claim submissions, documentation of related procedures and job aids, and reconciliation of amounts receivable. The role analyzes Power BI reports, identifies billing discrepancies or reimbursement risks, delegates required corrections or reimbursement tasks to pharmacy technicians and reimbursement specialists, and follows each file through to complete resolution. This position requires close collaboration with the pharmacy team, reimbursement specialists, insurers, manufacturers, PSPs, patients and the finance team.

Requirements

Experience in specialty pharmacy, patient support programs, reimbursement, insurance, claims, accounts receivable or operational analysis.
Strong understanding of private insurance, RAMQ, special authorizations, copay cards, financial assistance programs and billing issues related to high-cost medications.
Experience with Kroll is strongly preferred.
Strong Excel skills and ability to analyze Power BI reports; direct Power BI experience is considered a strong asset.
Comfort working with multiple technology platforms, including Xero, SAP Ariba, PSP/manufacturer portals and internal systems.
Ability to coordinate, delegate and follow up on the work of reimbursement specialists or pharmacy technicians.
Excellent organizational skills, high level of accuracy and strong attention to detail.
Ability to manage several complex files simultaneously and prioritize based on patient, operational and financial risk.
Excellent verbal and written communication skills in French and English.
Self-starter with strong judgment, proactivity and ability to work with a high degree of independence.

Nice To Haves

Your commitment to providing a high level of service to your internal and external clients.
You are highly adaptable with a track record of success during times of growth and organizational change.
You have a proven track record of developing trust and influence at multiple levels.
You demonstrate an impactful and candid communication style.
You have exceptional organizational skills with the ability to build effective working relationships with colleagues, management, and stakeholders.

Responsibilities

Manage and monitor claims related to specialty medications, patient financial assistance and amounts advanced by the pharmacy.
Verify that medications have been approved by public or private insurers before billing or dispensing, when required.
Identify files where insurance approval is missing, denied, incomplete, expired or inconsistent with billing requirements.
Perform the required follow-up with insurers, manufacturers, PSPs or other stakeholders, and delegate tasks to reimbursement specialists when appropriate.
Oversee delegated reimbursement files until resolution, including special authorizations, renewals, denials, appeals, missing documents and processing delays.
Analyze Power BI reports to identify billing errors, payment discrepancies, amounts to be claimed, unreimbursed amounts and high-risk files.
Validate information in Kroll, including insurance coverage, third-party payer restrictions, applicable codes, benefit coordination, patient amounts and service dates.
Direct necessary corrections to pharmacy technicians, provide clear instructions and confirm that transactions have been corrected appropriately.
Submit reimbursement claims to manufacturers or PSPs, including through PSP portals, SAP Ariba or any other applicable platform.
Collaborate with the accounting team to reconcile amounts receivable, reimbursements received and related entries in Xero.
Maintain structured tracking by patient, medication, manufacturer, program, insurer, amount receivable and reimbursement status.
Develop, write, implement and maintain procedures, job aids, quick-reference guides, instructions, checklists and other documentation related to reimbursement, financial assistance submissions, claims management and related workflows.
Prepare periodic follow-ups on open claims, pending amounts, reimbursement delays, identified discrepancies and recurring issues.
Escalate problematic files promptly in order to limit financial losses, treatment delays and patient access issues.
Participate in the continuous improvement of procedures, tracking tools, Power BI reports and claims/financial assistance workflows.
Maintain patient confidentiality and comply with internal policies, SOPs and applicable regulatory requirements.
Perform any other administrative, operational or related duties that may be required as part of the role and responsibilities assigned by management.