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Specialty Pharmacy Support Expert

2 months ago

Louisville, Kentucky, United States EBlu Solutions LLC Full time
Job Description

Overview

eBlu Solutions LLC is seeking a highly skilled and experienced Provider Relations Support Specialist to join our team. As a key member of our Provider Relations Success Team, you will play a critical role in supporting patient access to care through the support of healthcare providers, pharmaceutical company representatives, and healthcare service companies for specialty prescription drugs.

Responsibilities

  • Provider Support
    • Maintain accurate and up-to-date provider information in our company database
    • Register and maintain practice and provider records in clearinghouses
    • Support, monitor, and resolve pending activity in specific statuses within our workflow
    • Assist in the collection and verification of provider documentation and credentials
  • Meeting Coordination
    • Schedule and coordinate meetings, training sessions, and events for the Provider Relations Success Team
  • Education and Training
    • Exhibit the ability to develop, maintain, and facilitate the education of our portal capabilities and enhancements to healthcare providers
  • Expertise
    • Expertise in medical benefits and policy with an understanding of the dynamics of Buy and Bill and Specialty Pharmacy
    • Understanding of pharmacy benefits and policy
    • Exhibits the ability to provide live face-to-face and virtual engagements, using approved tools, to support and address questions to educate physician office staff on the use of our platform
  • Collaboration and Communication
    • Support provider experience through collaboration with the Provider Relations Success Team
    • Adapts and pivots for change and complexity
    • Collaborate with internal stakeholders appropriately to share insights into customer needs, potential barriers, and payer issues/opportunities for product access
  • Reporting and Compliance
    • Assist in monitoring and reporting on compliance-related issues
    • Prepare reports, presentations, and other documentation as needed
  • Other Responsibilities
    • Collaborate with other departments to address provider needs and improve service delivery
    • Participate in team meetings and contribute to the development of strategies to enhance provider relations
    • Other duties and responsibilities as assigned by the supervisor based on business needs

Requirements

Physical and Technical Environment

  • Ability to work at a desk and computer in the office for long periods of time
  • Ability to maintain focus under high levels of pressure and multiple priorities
  • Ability to travel, overnight up to 5%
  • Ability to travel independently to client sites; if, by car, a valid driver's license or reliable method of transportation is required

Required Experience

  • 2 or more years of healthcare industry experience are required
  • A minimum of 2 years experience in the healthcare industry with a strong understanding of the following:
    • Insurance verification
    • Claim adjudication - physician office, and outpatient billing
    • Understanding of Buy and bill processes
    • Understanding of payers Medicare, Tricare, Medicaid, and National and Regional Commercial payers
  • Experience working with office-administered drugs and/or infusion centers is preferred
  • Understanding in access and reimbursement issues surrounding coverage:
    • Appeals Prior authorizations
    • Appeals
    • Exceptions
    • Denials
    • Coding and payer payment guidelines, payer policies, sites of care
    • Understanding of coding guidelines (CPT/J-Code/ICD-10)
    • Quality programs related to value-based care and clinical care pathways
  • Interpersonal skills including managing and resolving conflict and building strong working relationships
  • Ability to adapt to change and react constructively in a high-energy and fast-paced environment
  • Ability to apply strategic thinking, analytical, and communication skills preferred
  • Working knowledge of drug reimbursement issues
  • Exhibits an Advanced Beginner working knowledge in Microsoft Office Suite
  • Understanding of Health Plan Medical Policies and Prior Authorization Criteria
  • Knowledge of HCPCS, CPT, and ICD-9 coding
  • Ability to follow instructions and resolve problems independently
  • Exceptional attention to detail

Required Education

  • High school diploma or equivalent required
  • Bachelor's degree in a related field or equivalent experience is preferred