Spécialiste de remboursement, maladies rares / Bilingual Reimbursement Specialist, Rare Diseases

Cencora

About The Position

Our team members are at the heart of everything we do. At Cencora, we are united in our responsibility to create healthier futures, and every person here is essential to us being able to deliver on that purpose. If you want to make a difference at the center of health, come join our innovative company and help us improve the lives of people and animals everywhere. Apply today! Job Details Principales Fonctions et Responsabilites: Contrat de 14 mois Communication quotidienne et continue avec le gestionnaire de programme ou le gestionnaire de programme adjoint pour les projets nouveaux et existants; Démontrer une connaissance approfondie des programmes de maladies rares offerts, y compris la physiopathologie de la maladie, le produit, le domaine thérapeutique, le processus de la maladie, et le mécanisme d'action, et comment appliquer les PONspour les maladies rares; Démontrer une connaissance approfondie des mécanismes de financement public/privé et fédéral ainsi que des organismes de financement des maladies rares (États-Unis et Canada). Coordonner les cas avec les médecins et les professionnels de la santé afin de préparer des soumissions répondant aux spécifications et aux critères spécifiques établis par les payeurs des secteurs public et privé. Coordonner et gérer tous les aspects nécessaires à l'obtention d'une couverture des médicaments d'ordonnance pour les patients; Coordonner les cas avec les compagnies d'assurance, les bureaux de médecins et les professionnels de la santé afin de maximiser les solutions de remboursement; Parcourir le processus complexe de démarches pour obtenir une couverture pour les médicaments d'ordonnance et le remboursement de ces médicaments coûteux et qui sauvent des vies; Coordonner les documents, les soumissions et tous les documents connexes aux compagnies d'assurance et aux programmes de financement public/fédéral; Mettre en œuvre le test de moyens financiers tel que requis dans le but de maximiser la couverture des médicaments d'ordonnance du patient Coordonner les processus de pharmacie requis lorsque le financement a été obtenu; et Le/la spécialiste de remboursement sera également affecté(e) à d'autres fonctions et tâches au besoin de temps à autre. Primary Duties and Responsibilities: 14 Month Contract Daily and ongoing communication with Program Manager / Associate Program Manager for new and existing projects; Demonstrate in depth knowledge of rare disease program offerings, including the pathophysiology of the disease/product, therapeutic area, disease process, and mechanism of action; and how to apply rare disease SOPs; Exhibit in depth knowledge of public/private and federal funding mechanisms as well as Rare Disease funding bodies (US and Canada). Coordinate cases with physician and healthcare professionals in order to prepare submission meeting specific specifications/criteria set by public/private payers. Coordinate and manage all aspects required in order to obtain prescription drug coverage for patients; Coordinate cases with insurance companies, physician’s offices and healthcare professionals in order to maximize reimbursement solutions; Navigate through the complex lobbying process to obtain prescription drug coverage and reimbursement for these life-saving and costly medications; Coordinate documents, submissions and all related paperwork to insurance companies, public/federal funding programs; Implement Financial Means Test as required in an effort to maximize patient’s prescription drug coverage Coordinate pharmacy processes required once funding has been obtained; Responsible to report all Adverse Events to the assigned units/departments; The Reimbursement Specialist will also be assigned other duties and tasks as required from time to time.

Requirements

Minimum of 3 years’ experience in the pharmaceutical, insurance or healthcare-related industries
Previous experience in reimbursement and Knowledge of public, private and federal reimbursement is required
Minimum of three (3) years’ experience in a Customer Service setting
OR Five (5) years or more tenure as a Sr. Reimbursement Specialist Professional / courteous / efficient telephone manner
Strong proficiency in Microsoft applications (Outlook, Word, Excel)
Proven ability to organize time, set priorities and multi-task in order to meet various competing work deadlines
Candidate must have strong communication and interpersonal skills, including the ability to communicate with patients in a healthcare setting on extremely sensitive topics
Ability to work independently and in a team environment
Attention to detail

Nice To Haves

Bilingualism, French/English is an asset.
Advanced knowledge of pharmaceutical, or insurance industry
Strong business and financial acumen
Strong analytical and mathematical skills
Ability to communicate effectively both orally and in writing
Effective interpersonal and leadership skills
Effective organizational skills; attention to detail
Ability to consistently meet deadlines
Excellent problem-solving skills; ability to resolve issues effectively and efficiently
The successful candidate may have daily contacts with unilingual English-speaking customers, patients or peers from cross-functional teams.

Responsibilities

Daily and ongoing communication with Program Manager / Associate Program Manager for new and existing projects
Demonstrate in depth knowledge of rare disease program offerings, including the pathophysiology of the disease/product, therapeutic area, disease process, and mechanism of action; and how to apply rare disease SOPs
Exhibit in depth knowledge of public/private and federal funding mechanisms as well as Rare Disease funding bodies (US and Canada)
Coordinate cases with physician and healthcare professionals in order to prepare submission meeting specific specifications/criteria set by public/private payers
Coordinate and manage all aspects required in order to obtain prescription drug coverage for patients
Coordinate cases with insurance companies, physician’s offices and healthcare professionals in order to maximize reimbursement solutions
Navigate through the complex lobbying process to obtain prescription drug coverage and reimbursement for these life-saving and costly medications
Coordinate documents, submissions and all related paperwork to insurance companies, public/federal funding programs
Implement Financial Means Test as required in an effort to maximize patient’s prescription drug coverage
Coordinate pharmacy processes required once funding has been obtained
Responsible to report all Adverse Events to the assigned units/departments
The Reimbursement Specialist will also be assigned other duties and tasks as required from time to time.