In this dynamic role as a Provider Relations Support Specialist, you will have the opportunity to support patient access to care through the support of healthcare providers, pharmaceutical company representatives, and healthcare service companies for specialty prescription drugs who can encounter reimbursement and billing challenges. The Provider Relations Support Specialist team focuses on supporting practices, accounts, and healthcare providers with the necessary support materials and education to seek coverage for therapy for appropriate patients.

The Provider Relations Support Specialist is the primary liaison between the eBlu Solutions Provider Relations Success Team members and the eBlu Solutions portal. Responsible for supporting the team, maintaining positive relationships, resolving issues, and ensuring efficient communication. This role will involve assisting with provider inquiries, updating provider information, and coordinating with the team to ensure proper set-up across multiple platforms. Additionally, this role is working to develop the competencies to lead client meetings successfully and efficiently; interpret client needs, and develop appropriate action and implementation plans; while working closely with the eBlu Solutions’ Leadership team to monitor, assess, and identify strategies to enhance program processes. 

Provider Relations Support Specialist – Responsibilities 

• Maintain accurate and up-to-date provider information in the company database
• Register and maintain practice and provider records in clearinghouses
• Supports, monitors, and resolves pending activity in specific statuses within the eBlu Solutions workflow
• Assist in the collection and verification of provider documentation and credentials
• Schedule and coordinate meetings, training sessions, and events for the Provider Relations Success Team
• Exhibits the ability to develop, maintain, and facilitate the education of the eBlu Solutions’ 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
• 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 the eBlu platform
• 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 
• Exhibits the ability to understand how to monitor Practice utilization of eBlu Solutions’ 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
• 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