National Lead Reimbursement under the direction of the PSS Director will lead the reimbursement function and develop a leading capability nationally in reimbursement and drug navigation. They will demonstrate strong knowledge and insights into changes in the payer and regulatory landscape and drive Bayshore Specialty Rx knowledge and understanding.

DUTIES AND RESPONSIBILITIES

Program Development

• Maintain strong knowledge of the payer landscape, interpreting new laws and regulations for the BSRX business.
• Develop training, user guide and tools to train on reimbursement and drug navigation
• Develop and execute robust reimbursement strategies
• Develop and execute first, second and third level appeal processes
• Assist reimbursement team leads with the analysis of reimbursement records to produce favorable outcomes
• Assist with the Implementation of contractual agreements specific to the pharmaceutical client, as it relates to Reimbursement services
• Lead the reimbursement monthly meetings, training and key knowledge sessions following key conferences for knowledge exchange. ( ie CADTH, SADIE)
• Report and document Adverse Events as per PV requirements
• Develop program specific drug therapy, protocols and field training materials in collaboration with the Implementation Manager, as it relates to Reimbursement services
• Implement, execute and update processes to achieve better performance keeping current with changing business needs and direction, regarding Reimbursement services
• During the program transition: communication of related processes, patient volumes and KPI/financial data occurs on an ongoing basis with PSS, Bayshore management team, and field staff related to Reimbursement services

Reimbursement Manager

• Execute and update processes to achieve better performance keeping current with changing business needs and direction.
• Develop reimbursement and patient advocacy policies for distribution
• Promote and foster relationships with national and regional stakeholders and pharmaceutical client reimbursement staff
• Act as a SME for advocacy and reimbursement strategies
• Provide database & reimbursement training, to front line staff as well as supporting business units on the implementation
• Participate in required RFPs as Reimbursement Subject Matter Expert, including participation in RFP proposals and writing
• Employee will maintain relevant level of knowledge of ICH (International Conference on Harmonization), GCP (Good Clinical Practice) and Health Canada GVP (Good Pharmacovigilance Practices) guidelines appropriate to their hired role which is to be provided at time of hire and annually. With this knowledge the employee will perform the work as required by their assigned function and will be provided with regular updates as required.
• Adhere to Bayshore Policies and Procedures
• Participate in proactive Health & Safety activities while performing all duties. Is responsible to notify immediate Supervisor of any Health & Safety risks or concerns.
• Maintains confidentiality of client and corporate information and discusses same only with appropriate Bayshore personnel

REPORTING RELATIONSHIPS

The National Lead Reimbursement reports directly to the Director, Patient Support Services.

• Bachelor’s Degree in Business, Healthcare Management, or equivalent, or a minimum of 5 years of Reimbursement experience
• At least three years of progressively responsible recent experience in the home health care or pharmaceutical industry, one of which was at a supervisory or management level; demonstrated ability to interpret and integrate policies and procedures; solid track record in conducting adult education initiatives and proven track record as a project manager.
• Demonstrates time management skills as well as an ability to evaluate urgent situations and make appropriate decisions
• Excellent communicator with strong computer skills
• Valid driver’s license and willingness to undertake out-of-town travel as required
• Working knowledge of French language

Other Skills and Abilities

Knowledge of:

• The principles, practices and methods of business development
• Operations and service delivery
• Financial management and control
• Program development, implementation and evaluation
• Human resources practices