Provider Relations Support Specialist

2 weeks ago

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

We are seeking a highly skilled Provider Relations Support Specialist to join our team at EBlu Solutions LLC. In this dynamic role, you will play a critical part in supporting patient access to care through the support of healthcare providers, pharmaceutical company representatives, and healthcare service companies for specialty prescription drugs.

Key Responsibilities
  • Maintain accurate and up-to-date provider information in our 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
  • Schedule and coordinate meetings, training sessions, and events for our Provider Relations Success Team
  • Exhibit the ability to develop, maintain, and facilitate the education of our portal capabilities and enhancements to healthcare providers
  • 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
  • Exhibit 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
  • Support provider experience through collaboration with our Provider Relations Success Team
  • Adapt and pivot for change and complexity
  • Collaborate with internal stakeholders appropriately to share insights into customer needs, potential barriers, and payer issues/opportunities for product access
  • Exhibit the ability to understand how to monitor Practice utilization of our services
  • Address and resolve provider issues and concerns in a timely and effective manner
  • Escalate complex issues to the Provider Relations Manager or appropriate team members when necessary
  • Assist in monitoring and reporting on compliance-related issues
  • Prepare reports, presentations, and other documentation as needed
  • 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
Requirements
  • 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
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

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