Primary Duties and Responsibilities:

• Conducts analysis of the reimbursement services rendered from patient enrolment date to being on-drug by analyzing the patient files, case notes and monitoring the related calls 

• Learns the program specific reimbursement processes and criteria by reviewing the reimbursement documents, SOPs, Work Instructions (WIs) shared drives, training materials, product monographs and meeting with program point of contacts 

• Conducts the file reviews as per established audit schedule including conducting call monitoring via the relevant Avaya (NICE), I3 (ICBM) or Five9 phone system where and when applicable 

• Provides associates with feedback on the evaluated files using the reimbursement excellence scorecard and includes written feedback on areas of strengths and areas of opportunities 

• Completes call evaluations utilizing the phone technology, scorecard and sampling, providing associates with coaching written feedback on areas of strengths and opportunities to improve their customer service skills and positioning of our services with patients 

• Conducts face to face sessions with assigned associates to provide personalized coaching and support to reinforce their understanding of the customer service principles and skills, reimbursement processes, best practices, and training as well as their overall reimbursement expertise 

• Conducts ad hoc coaching sessions upon associates’ requests to address specific needs and provide timely feedback on the reimbursement processes, call handling, etc. 

• Establishes relationships with the program management team and provides team specific data and feedback to develop a collaborative approach between program management and the reimbursement excellence team in order to improve the reimbursement services rendered 

• Utilizes the various systems and develops related expertise (e.g., smartsheet, excel, phone systems, databases, etc.) to run reports, analyze the data and identify gaps in processes and opportunities for efficiencies 

• Maintains audit tracking tool on a weekly, monthly, and quarterly basis including employee departures, leaves and new associate additions 

• Participates actively in the calibration process to ensure the credibility and consistency of the quality monitoring and ensure alignment amongst the Performance Optimization team 

• Supports and implements audits that focuses on specific topics/skills 

• Participates in activities that support the establishment of quality metrics, and proposes continuous process improvements (processes, training solutions, etc.) 

• Responsible for utilizing all technology and resources effectively and efficiently 

• Provides feedback to assist in the creation of quality standards, performance improvement goals, training opportunities and the development of training programs 

• Participates in the establishment and implementation of strategies for associates’ recognition 

Experience et Niveau d'Education Requis:

• Exige une solide formation dans des domaines comme l’administration des affaires, les opérations, l’amélioration continue des processus et l’assurance de la qualité. 

• Diplôme obtenu dans le cadre d’un programme de baccalauréat ou combinaison équivalente d’expérience et d’éducation d’au moins 3 à 5 ans. 

• Connaissance et expérience des programmes pour les patients et des services de remboursement obligatoires. 

• Un à deux ans d’expérience en accompagnement professionnel. 

• Une expérience en matière d’assurance de la qualité ou d’amélioration des processus est un atout. 

• Le bilinguisme est un atout. 

Competences, Connaissances et Aptitudes Requises:

• Attitude et approche positives, axées sur l’esprit d’équipe, pour accomplir le travail. 

• Axé sur le client. 

• Démontrer de très bonnes compétences en matière de communication interpersonnelle et de partenariat. 

• Excellente communication verbale et écrite, avec la capacité de communiquer au sein d’équipes interfonctionnelles/organisationnelles. 

• Capacité à travailler de manière indépendante. 

• Excellentes aptitudes de gestion du temps et capacités d’effectuer plusieurs tâches à la fois. Capacité à établir des priorités, à organiser et à planifier le travail. 

• Capacité à résoudre efficacement les problèmes et à analyser et interpréter les données au niveau de l’entreprise. 

• Capacité à faire face efficacement au changement et à décider et agir sans avoir une vue complète de la situation. 

• Un haut niveau d’attention aux détails. 

• Fiable, plein de ressources, capable d’influencer sans autorité, connu comme ayant un sens de l’initiative. 

• Connaissances des logiciels Microsoft Word et Excel. 

 Experience and Educational Requirements:

• Requires broad training in fields such as business administration, operations, continual process improvement, and quality 

• Completion of a year Bachelor’s degree program or equivalent combination of experience and education of at least 3-5 years 

• Patient programs and reimbursement services knowledge and experience mandatory 

• 1-2 years of business coaching experience 

• Quality and/or process improvement experience an asset 

• Bilingual an asset 

Minimum Skills, Knowledge and Ability Requirements:

• Positive, team-oriented attitude and approach to getting work done 

• Customer focused 

• Demonstrates strong interpersonal and partnership skills 

• Strong verbal and written communication with the ability to communicate within cross-functional/ organizational teams 

• Ability to work independently 

• Strong time management skills and multi-tasking abilities. Ability to prioritize, organize and plan work 

• Ability to effective problem-solving and analyze and interpret business level data 

• Ability to effectively cope with change, and can decide and act without having the total picture 

• High level attention to detail 

• Reliable, resourceful, flexible, able to influence without authority, known for a sense of initiative 

• Knowledge of Microsoft Word, Excel software 

This posting is intended to fill an existing vacancy for our Performance Optimization role