Patient Service Specialist

Job Summary

The Patient Services Specialist is an integral part of the Patient Services team, responsible for providing administrative & patient counseling support to physician offices primarily to assist with the completion of paperwork and follow up on the submissions pertaining to obtaining drug reimbursement through private and provincial drug plans, relating to the patient support programs offered by McKesson Specialty. The focus of this position is to shorten the approval time for patients who are waiting to start therapy as well as providing value-added services in terms of time and resources to prescribing physicians on an as-needed basis. The role involves interactions with patients, insurance companies, pharmacies, physicians and other health care professionals (HCPs) to explore and obtain coverage for the prescribed medication as well as management of the patient cases.

This position operates on a 37.5‑hour work week, with flexibility to schedule a 7.5‑hour shift anytime within the program’s operating hours of 8:00 a.m. to 8:00 p.m. EST.

Specific Responsibilities

• Liaise with the patient, insurer and physician regarding the documentation required for maximum reimbursement coverage, including the exploration of all public and private insurers and providing employer escalations as required.
• Responsible for escalation management in cases where assistance beyond program scope is required.
• Gather all pertinent and appropriate information from the patient chart and complete necessary documents in a concise, organized and professional manner and submit physician signed forms to the private and/or provincial drug benefit insurer/agency.
• Follow up with applicable insurers until a decision is received, with the intent of expediting a decision where possible. If the submission has been denied, the Senior Patient Services Specialist will discuss this with the physician and resubmit if agreed upon.
• Updates with respect to the reimbursement submissions, confirmation of coverage and re-submissions will be entered into the patient database.
• Complete follow ups with patients on behalf of the physician offices, as required, to ensure adherence to treatment regimens.
• Provides information and updates to physicians and staff in their offices regarding the medication in terms of new criteria and indications as received from McKesson Canada or the Client.
• The Senior PSS may be asked to do stretch assignments for the client.
• Assist with client escalations for the program as needed.
• Provide support to the team by answering any questions, problem solving and assigning tasks.
• Provide support to PM/APM by assisting in tasks such as; authoring deviations, call reviews privacy incidents and AE reconciliations as requested.
• Act as a SME for the program, assists in the development of training material for the team if needed.
• Continuously provide best practice guidance to the team.
• Receive, record and report Adverse Events as per the Pharmaceutical Manufacturer requirements.
• Participate and assist in departmental continuous improvement activities related to process, quality, training etc.
• Maintain service levels in case management, including Adverse Events reported within twenty-four hours of receipt and any other Key Performance Indicators established at the Program level.
• Perform data-entry, answer inbound calls, make outbound calls, manage e-mail and fax software, general administrative functions including faxing, filing, scanning.

Minimum Qualifications

• High school diploma or equivalent required.
• A minimum of 1 year of related experience in a healthcare, clinical, or administrative setting.

Key Competencies

• Previous experience with Patient Support Programs (PSPs) is highly preferred.
• Strong customer service, communication, problem solving skills required.
• Bilingualism (French/English) is an asset.
• Proficient in Microsoft Office applications (Word/Excel).
• Team Player and comfortable working independently.
• Thorough knowledge of adult learning principles and training.
• Organized with a high attention to detail.
• Understands and applies techniques to manage multiple priorities.
• Possesses a high level of motivation to achieve necessary involvement within a team.
• Stress can be a factor of the position because of the variety of duties and prospects of peak periods in certain situations due to the reality of medical management. Work is often performed in emotional situations.
• May operate a vehicle usually locally.