Specialty Pharmacy Billing Specialist; Hybrid Job Mississauga area,Ontario Canada,Healthcare

Position: SPECIALTY PHARMACY BILLING SPECIALIST (HYBRID)

WHO WE ARE
When it comes to health, we’re always looking for waysto push for better. It’s why we were founded in the first place. In 1957, our founder, pharmacist William Wilkinson, witnessed a mother sacrifice her health by forgoing her own medicine to pay for her sick daughter’s prescription. He knew there had to be a better way. So, he introduced North America’s first prepaid drug plan, and Green Shield was born as a not-for-profit with a mission to support better health for all Canadians.

We aren’t just a health and benefits company. We’re the only not-for-profit social enterprise that brings worlds of coverage and care together, all in one place.
We’re noble challengers, purposefully building a better way and we need the best people to help us create a more holistic approach that takes care of the mind and body.

Our mission is to create better health for all Canadians, and we know that starts with our employees.

THE ROLE IN A NUTSHELL

Green Shield Administration provides innovative health benefit solutions for the small-mid size companies in Canada. Recognized as the leading alternative to the traditional insurance companies, in a market where small and mid-sized employers have been largely underserved Green Shield Administration sets itself apart from the competition, by using technology, creative product development and a stellar customer experience to solve problems for employers.

Honeybee Benefits is our next generation benefits platform built for today’s modern workforce that empowers employers to compete better for talent.

Scoping across all Green Shield Specialty Pharmacies, the Specialty Pharmacy Billing Specialist is a patient-facing role focused on coordinating out of pocket payments with patients and Patient Support Programs (PSPs) and updating profiles in the pharmacy software, Kroll. This role serves as a key liaison between the pharmacy, Patient Support Programs (PSPs), and third-party insurers to reconcile payments, resolve billing discrepancies, collect payments, and manage retroactive billing (retro-billing) processes.

Manage Specialty Pharmacies’ patient AR accounts, including following up with patients via phone calls and emails to collect outstanding amounts and provide guidance through the provincial plans and PSP Portals

Organizing and submitting co-pay amounts to PSPs using Kroll software

Reconciling payments received from PSPs and patients with their Kroll accounts

Supporting the Specialty Pharmacies with Retrobilling, including assessing if/when insurance coverage is established, backdating any applicable claims through the pharmacy software within acceptable window, invoicing PSPs for medications used to bridge patient while coverage was pending

Supporting the Specialty Pharmacies with billing optimization initiatives ensuring all claims are being submitted appropriately and efficiently

WHO WE'RE LOOKING FOR

We're not looking for just anyone. We’re looking for a unique individual with a big brain and a big heart who wants to help us create better health for all Canadians.

+5 years as a pharmacy assistant in Specialty Pharmacy

+3 years in bookkeeping, accounting or invoicing in a pharmacy or healthcare setting

Experience working with PSP and third party payment portals

Understanding co-pays, deductibles, and out-of-pocket costs

Understanding PSPs and the Retrobilling process

Understanding how to navigate Trillium and other public plans

Patient payment collection (following up with patients, clearly explaining co-pays / deductibles)

Claims submission & PSP Management (submitting and tracking payments, logging claim statuses and escalations, following up on delayed or denied claims)

Retro-billing and Corrections (billing discrepancies and timely reimbursement)

NICE TO HAVE

Experience with Kroll considered an asset

Experience in patient collections and third party billing

Experience working with PSP and third party payment portals

THE CULTURE
We believe a career should be meaningful. Not just a means to earn a living. Our culture is one where everyone's voice is heard and valued. Because that’s what it takes to create better health for all. We dare to challenge the status quo. And we’re…


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