eBlu Solutions was founded in 2012 to help specialty medical practices manage the complex workflow associated with highcost infusion and injection treatments. Simply put, our solution gets patients to treatment faster.

The Manager or Payer and Authorization Services oversees the Prior Authorization and Payer Research teams ensuring quality of work, queue management, team member development, and scaling the department in line with growth objectives. This role handles the more complex issues and ensures verification accuracy through reviews, auditing, and oversight. This position will report to the Director or Provider Services.

Note: This position will initially be in-office 5 days a week during normal business hours. After a 60-day evaluation period, eligibility for a hybrid work schedule with 2 required in-office days per week may be granted.

• Prior Authorization SME
• Oversees employee attendance, including time off requests to ensure appropriate staffing to meet business needs
• Monitors, supports, and ensures company MBOs and team KPIs are met and/or exceeded
• Reviews all documentation related to employee performance, including disciplinary action
• Onboard and mentor new employees ensuring a successful transition within the team
• Once new drugs are added to the system, adds diagnosis codes to the system as needed
• Ensures medical policies and Prior Authorization forms are added for new drugs
• Provide oversight and supervision of assigned operations staff including performance management.
• Gather and analyze data as necessary to drive and improve employee performance including a yearly evaluation of team expectations
• Monitor employee performance closely to ensure we are identifying and addressing issues as quickly as possible
• Audit various queues to ensure TATs are being met
• Monitor Secure Messaging from Practice Partners to identify issues, correct errors, and identify training opportunities
• Monitor Secure Messaging sent for internal review by the team to identify issues, correct errors, and identify training opportunities
• All feedback found from the Quality team should be addressed during 1:1s with team members and documented in the HRIS
• Management of the team documents, training workflows, and Standard Operating Procedures, etc.
• Lead 1:1s to ensure team members receive support, guidance, and are in a position to be successful
• Monthly for team members meeting minimum expectations and biweekly for team members not meeting minimum expectations
• All team members are entitled to request additional 1:1 time
• Collaborates with the Training and Development team to ensure alignment and clear communication and expectations of the teams
• Demonstrates critical thinking by continuously evaluating where we could increase our automation rates and ensures team members are sharing ideas
• Updates Payer Notes and Portal Access
• Participates in meetings with Developers to ensure we are assisting in understanding the needs of Operations
• Actively listens to calls in Ring Central to identify training opportunities or to gather important information from the call
• Complete shoulder to shoulders bi-weekly on all team members not meeting minimum expectations or who have requested additional support
• Follow up on employee IDPs (Individual Development Plans) as needed
• Provide the highest level of customer service when representing eBlu
• Promote consistency by following the guidelines in the employee handbook
• Queue management of inventory, effective prioritization, and turnaround times
• Employee development i.e. interviewing, hiring, and training.
• Perform system testing as needed • Maintains all patient and employee confidentiality
• Other duties and responsibilities as assigned by the Director based on the specific client contract

EXPERIENCE, SKILLS & QUALIFICATIONS

EDUCATION

• High School Diploma or GED required
• Bachelor's degree preferred or equivalent work experience

EXPERIENCE

• 3-5 years previous experience in a health plan, facility, healthcare provider office, or pharmaceutical industry required
• Previous supervisory experience required
• 3-5 years call center experience preferred
• Knowledge of medical terminology preferred
• Strong understanding of health plan medical policies and prior authorization criteria
• Experience working with insurance companies and extensive knowledge of different types of coverages and policies
• Ability to work independently without direct supervision and perform work directly related to general business operations
• Ability to exercise discretion and independent judgment that has a potential impact on the company and/or our clients
• Ability to calculate figures and amounts such as discounts and percentages; necessary to provide correct benefit and co-pay information
• Understanding of Buy & Bill 3.

SKILLS

• Must have excellent multitasking skills to allow for success in the role
• Ability to pull, organize and analyze data to help drive performance
• Must be very detail-oriented and organized to maintain accurate patient insurance records
• Strong communication and interpersonal skills with both internal and external partners
• Ability to work independently, as well as collaboratively in a team environment.
• Proactive and able to take initiative in driving projects forward
• Ability to resolve problems independently
• Ability to follow instructions and meet deadlines
• Ability to focus and work quickly within a 24-hour turnaround for patient insurance information
• Ability to manage multiple priorities concurrently
• Ability to accept constructive feedback
• Ability to direct the work of other team members
• Strong computer skills; preferably Microsoft Word or Excel software applications

PHYSICAL & TECHNICAL ENVIRONMENT

• Ability to work at a desk in the office for long periods of time.
• The 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.

BENEFITS

• Competitive pay and performance-based incentives
• Comprehensive health, dental, and vision insurance
• Retirement savings plan with company matching.
• Flexible schedules with both remote and hybrid work options.
• Professional development and growth opportunities
• Generous paid time off and holiday schedule.

EBLU SOLUTIONS IS AN EQUAL OPPORTUNITY EMPLOYER - eBlu Solutions seeks talent from all backgrounds to bring 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.