Specialty Pharmacy Billing Specialist - Hybrid

WHO WE ARE

GreenShield is a proudly Canadian, national non-profit health care and insurance organization, driven by our mission of Better Health for All. We believe health care is a right, not a privilege, and we are committed to improving health outcomes, advancing health equity, and building a future where every Canadian can reach their full health and well-being potential.

Through our unique integrated payer-provider ("payvider") model, we offer insurance, administer benefits, and pay claims as a ‘payer’ while offering health care services such as mental health, pharmacy, telemedicine, and chronic disease management as a ‘provider’.  As a non-profit social enterprise without shareholders, we reinvest our excess earnings to directly support underserved communities. Through GreenShield Cares, we positively impacted the health and well-being of over one million Canadians between 2020 and 2025.  What’s driving us now is the commitment to measurably impact an additional three million Canadians by 2030 – across mental health, essential medicines, and chronic disease management – through scalable initiatives that deliver meaningful change in pursuit of our mission of Better Health for All.  

At GreenShield, our culture is where purpose meets passion and performance. Our teams work as one to deliver meaningful, measurable impact for the people and communities we serve.

THE ROLE IN A NUTSHELL

Base Salary:  CAD $51,383.00 - 79,261.00

GreenShield 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 GreenShield 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 GreenShield 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 driven by people who have challenged theirs.  We believe that your workplace should empower you to be the best version of yourself. That’s why we provide a place where you can be inspired, challenged, and rewarded. 
Where your growth means our growth.
Where your voice is heard and valued.
Where your work has purpose. And purpose matters.
We believe our people are critical to our overall success. Inclusivity makes us a stronger, smarter and more informed organization. Being intentionally inclusive of diverse backgrounds, perspectives and experiences will enhance our company culture to positively impact how we support our communities. A career at GreenShield isn’t just about personal achievements, it's about making a
difference together.
Here’s to Better Health for All!

A FEW MORE DETAILS

Proficiency in English is required for this position. As part of this role, you will be required to communicate with colleagues or customers who use English as their primary language.  By requiring English proficiency for this position, we aim to ensure that our employees can excel in their roles, collaborate, and communicate effectively, and contribute to the success of our organization. 

GS supports diversity, equity and inclusion in our teams and communities, and we value the unique contributions made by all. Even if your experience doesn’t align perfectly to every requirement, we invite you to apply.   We encourage applications from all candidates and will accommodate needs under human rights legislation throughout all stages of the recruitment and selection process. Please let us know of any accommodation through requestforaccommodation@greenshield.ca. Information received relating to accommodation will be addressed confidentially. 

Providing this information gives GS consent to use your personal information to assess your suitability for specific positions, future opportunities or for your personnel file. Your résumé will be held in strict confidence and will be viewed only by the Organization. Information may be stored outside of Canada and could be used for aggregate statistical purposes (which uses no personal identification). 

AI Usage - GreenShield leverages AI to help produce Job Descriptions, and ideate on interview questions. We also leverage AI for interview transcription support.