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Payer Research Specialist

2 months ago

Louisville, United States EBlu Solutions LLC Full time
Job DescriptionJob DescriptionDescription:

POSITION DESCRIPTION:

The Payer Research Specialist is responsible for investigating prior authorization and medical policy documents and putting them into the eBlu portal. They will manage the authorization process following client contract requirements and ensure medical policies are current and updated regularly.


RESPONSIBILITIES:

  • Maintain and update payer prior authorization and medical policies
  • Communication of updated form requirements and newly mapped forms
  • Work cross-functionally with management to implement process changes required to remain in compliance with payer rules and regulations
  • Payer Research Specialist serves as the expert on Payer Policy
  • Maintain Payer Database and complete payer date updates as requested by users
  • Researches and maintains payer medical policies and prior authorization forms as needed
  • Assist in payer trend analysis and reporting on payer revenue and other relevant information
  • Payer Research Specialist maintains a professional relationship with team members
  • Contribute payer updates for inclusion in education communication to end users
  • Able to work independently without direct supervision and perform work directly related to the management or general business operations
  • Able to exercise discretion and independent judgment that has a potential impact on the company and/or our clients
  • Able to direct the work and be approachable to other team members and communicate with the Team Lead
  • Payer Research Specialist can express ideas clearly in both written and oral communications.
  • Other duties and responsibilities as assigned by the supervisor based on the specific client contract


Requirements:

REQUIRED EXPERIENCE:

  • Two to three years of experience in payer policy and authorization form.
  • Understanding of Health Plan Medical Policies and Prior Authorization Criteria
  • Must have excellent multitasking skills.
  • Must be very detail-oriented and organized.
  • Must work well with others as part of a team in a close environment
  • Must have experience working with insurance companies and have extensive knowledge of different types of coverage and policies.
  • Awareness of where to prioritize time and focus to complete all daily workloads (Excellent Time Management).
  • Demonstrated database reporting skills and experience necessary to maintain databases and develop reports.
  • Experience interpreting and applying complex payer regulations/policies.
  • Superior communication, problem-solving, and analytical skills.
  • Ability to apply analytical findings to day-to-day detailed-oriented and self-motivated

PREFERRED EXPERIENCE, SKILLS, AND ABILITIES:

  • Knowledge of Medical Terminology preferred
  • Knowledge of HCPCS, CPT, and ICD-10 coding
  • Strong computer skills required, preferably Microsoft Word or Excel software applications
  • Data entry skills required
  • Ability to resolve problems independently?
  • Ability to calculate figures and amounts such as discounts and percentages; necessary to provide correct benefit and co-pay information
  • Ability to follow instructions
  • Have exceptional attention to detail and excellent analytical, investigation, and problem-solving skills
  • Attendance must be in the acceptable range according to the eBlu attendance policy

PHYSICAL AND TECHNICAL ENVIRONMENT:

  • Ability to work at a desk in the office for long periods
  • Noise level in the work environment is moderate.
  • Specific vision abilities required by this job include close vision and color vision.
  • Ability to maintain focus under high levels of pressure/multiple priorities.

eBlu Solutions seeks talent from all backgrounds to bring a diversity of thought, agility, and capability to our organization. We promote a working environment where all employees are treated and rewarded fairly. We do not tolerate any form of discrimination that adversely affects individuals or groups based on national origin, race, color, religion, sex, gender, sexual orientation, marital status, disability, age, or any other legally protected aspect of a person’s identity.