Provider Relations Manager - Kentucky, Louisville

The announced job offer is made public by the firm: eBlu Solutions LLC and it was included in jobs list the date of: 2022-10-22 in the website greenenergyjobsonline.com.

It is announced that they have a job offer at the category of Array and the jobs location is in the state of Kentucky at the city Louisville, in the country US - at this current ZipCode: 40202

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Description:

In this dynamic role as a Provider Relations Manager, 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 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 Manager serves as the primary liaison between eBlu Solutions and the healthcare provider offices; leading client meetings; interpreting client needs and developing appropriate action and implementation plans, while working with the eBlu Solutions' Leadership team to monitor, assess and identify strategies to enhance program processes.

Provider Relations Account Manager - Responsibilities

• Develop, maintain and facilitate the education of the eBlu Solutions' portal capabilities and enhancements to clients
• Educational components for success include reimbursement (coverage, coding & payment), specialty pharmacy processes, provider support services (e.g., benefits investigation, prior authorization), and patient support resources (e.g., copay assistance programs, patient assistance programs)
• Expertise in medical and pharmacy benefits and policy
• Understands the dynamics of Buy and Bill and Specialty Pharmacy
• Serve as the key contact and lead for reimbursement and access support-related matters and are responsible for being the local market access expert on payer, policy, and processes and navigating systems to support patient access
• 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 the entire Reimbursement journey from start form submission through payer prior authorization to appeals/denials requirements procedures and forms
• Adapts and pivots to manage change and complexity: agility to flex when markets, policies, and dynamics change; proactive and reactive managing through conflict; navigates the complexity of accounts and patient journey
• Work with internal partners to build strategic patient access plans and objectives
• Collaborate with internal stakeholders appropriately to share insights into customer needs, potential barriers, and payer issues/opportunities for product access
• Effective account management: uncovering customer insights through effective questioning; critical thinking and problem-solving; disseminating data and information to partners
• Build and maintain strong relationships with Healthcare Providers and pharmaceutical reimbursement teams
• Monitor Practice utilization of eBlu services
• Prepare reports for management as needed
• Collaborates with the compliance team on program audits; works with the leadership team to address audit findings and implement corrective action.
• 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:

• 5 or more years of healthcare industry experience are required
• A minimum of 3 years experience in the healthcare industry with a strong understanding of the following:

Insurance verification

Claim adjudication - physician office, and outpatient billing,

Medical benefit procurement

Understanding of adjudication within Commercial and Government payers

Buy and bill model

Understanding of payers Medicare, Tricare, Medicaid, and National and Regional Commercial payers

Experience working with office-administered drugs and/or infusion centers is preferred

• Expertise in access and reimbursement issues surrounding coverage:

Prior authorizations

Appeals

Exceptions

Denials

Coding and payer payment guidelines, payer policies, sites of care,

Understanding of coding guidelines (CPT/J-Code/ICD-10),

Statutory or commercial pricing structures or mandates

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
• Strong strategic thinking, analytical, and communication skills required
• Working knowledge of drug reimbursement issues
• Understanding of Health Plan Medical Policies and Prior Authorization Criteria
• Knowledge of HCPCS, CPT, and ICD-9 coding
• Ability to negotiate favorable outcomes with payers and prescribers assisting in obtaining needed information and decisions
• Ability to follow instructions and resolve problems independently
• Exceptional attention to detail

Required Education

Bachelor's degree in a related field or equivalent experience is required.

PI