Reimbursement Navigator, Patient Experience

Summary of Purpose

The Reimbursement Navigator (RNav) is an integral part of the Patient Experience team, working in close partnership with the Clinical  Liaisons (CLs), Patient Experience Coordinator (PEC) and other outside PSP service providers.  The RNav role is responsible for the coordination and delivery of services related to the patient support programs offered by Otsuka Canada.  It involves supporting patients, nurses, physicians and other members of the Health Care team from a patient reimbursement journey perspective among other PSP activities.

The goal of the RNav is to partner with patients and the Health Care team to deliver an unparalleled customer experience with the most personalized and patient-centered care possible to ensure the best patient outcomes.

Responsibilities

Reimbursement Duties:

• Liaise with physicians’ offices, patients as well as public and private payers to help to secure reimbursement of Otsuka medications in a timely fashion;
• Assess patient coverage status and conduct reimbursement investigations to help determine reimbursement eligibility;
• Present available patient financial assistance solutions for prescribed Otsuka medications (e.g. co-pay cards, bridging of medication, etc.);
• Complete special authorization forms and special documentation forms to ensure uninterrupted access to Otsuka medications;
• Document reimbursement activities at different points during the patient treatment journey into the Salesforce Health Cloud customer relationship management system;
• Deliver services/programs consistent with Key Performance Indicators (KPIs) set forth for the programs.

General Duties:

• Ensure open dialogue with Otsuka Key Account Managers (specialty sales representatives) while protecting patient confidentiality;
• Follow the program protocols to ensure that the most appropriate next steps are scheduled to ensure continuity of service delivery to HCPs and patients;
• Report Safety Information, Product Quality Complaint and Customer Feedback as per Otsuka standard operating procedures;
• Exhibit an innovation and continuous improvement mindset. Provide feedback regarding current protocols, databases, processes and inter-departmental relationships;
• Act as a backup for the PSA as well as the PSLs during vacations and/or extended leave of absences;
• Attend and actively participate in annual All-Company Meeting and national/regional meetings, as required.

Qualifications and Key Competencies

• Experience in a related field is an asset;
• Knowledge of the Canadian drug access system is a strong asset;
• Experience in assessing, exploring and implementing reimbursement solutions in Canada is an asset;
• Related technical diploma is a requirement. A Bachelor’s degree is an asset.
• Experience in the therapeutic areas of nephrology and/or mental health is an asset;
• Strong customer service, communication, and problem-solving skills required;
• Demonstrate ability to prioritize and complete tasks based on relative importance and urgency;
• Demonstrate professionalism and integrity, have a strong understanding of ethical practices and boundaries between roles of HCPs and pharmaceutical employees and ensure respect for confidentiality;
• Proficient in digital platforms (laptop, tablet, smart phone, email, databases, PowerPoint, Excel, Word, PDF editing) and open to newer evolving technology;
• Ability to work independently with great autonomy;
• Experience in pharmaceutical industry is an asset;
• Strong team player with the ability to work in a highly collaborative and fast-paced environment;
• Organized with a high attention to detail;
• Flexibility in working hours (up to 8pm occasionally when contacting patients). Ability to work evenings or weekends as needed (not frequent).

Supervision of Others: None