Senior Parent Group Pharmaceutical Product Research Specialist

Description

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

JOB SUMMARY

We are seeking an experienced and detail-oriented Sr. Pharmaceutical Product Research Specialist to join our team in a fast-paced, high-accountability environment. This role is responsible for managing and processing call sheets with precision, ensuring timely movement through investigation, approval, and documentation queues in accordance with established service-level agreements. The ideal candidate will possess excellent research and investigative skills, demonstrate a strong understanding of payer portals and benefit calls, and provide top-tier customer service to both internal and external stakeholders. This position also requires proactive communication, critical thinking, and the ability to pivot across multiple responsibilities while maintaining accuracy and efficiency. 

Note: This position will initially be in-office 5 days a week during normal business hours. After training and initial ramp-up period, eligibility for a hybrid work schedule with 2-3 required in-office days per week may be granted. 

KEY RESPONSIBILITIES

• Completes call sheets accurately 
• Monitors Pending Investigation (PI) and Pending Approval (PA) queues to accurately and completely investigate, deactivate, move to the In Process (IP) queue, and approve call sheets without assistance from Supervisor 
• Effectively meeting SD SLA of 8 Customer Service Business Hours (CSBH) or less 
• Responsible for working all Parent Groups that fall into PI or PA 
• Builds parent group anytime there are 2+ groups needing to be associated 
• Responsible for training their fellow team members on building parent groups 
• SD BIs submitted prior to 3PM should be completed by EOD for same day 
• Unfilter at 3PM divide and claim all SD 
• If total amount of SD does not equal 20, claim a minimum of 20 in date submitted order 
• Focus on SD products first in the queue, then IMC, then work in order by the first submitted date and appointment date, unless otherwise directed by the Supervisor or Leadership 
• Claim call sheets in Pending Investigation based on the assigned region if filtered and fairly when filtered or unfiltered in the queues 
• Call sheets not completed within 75% (6 hours from submitted timestamp) will require an SLA reason to be entered – select the accurate/appropriate SLA reason 
• If an accurate/appropriate SLA is not listed, reach out to the Supervisor 
• No call sheets are to be left in a team member’s name at EOD, unless further investigation is needed or otherwise directed or assigned by the Supervisor or Leadership 
• Notes need to be made on the sheet explaining the why (I.e., why was the call sheet deactivated or moved to the ‘In Process’ queue, etc.) 
• BIs are expected to be returned with accurate information 
• If you are not 100% certain, reach out and ask for assistance or clarity 
• Detailed documentation in the Comments section (I.e., why a group is changed/being left the same, etc.) 
• Assistance in the In Process (IP) queue may be needed to ensure TATs are met 
• This may include calling to follow up on red flags or modified calls 
• Understands and adheres to the eBlu Guarantee 
• Provides prompt communication to the Supervisor for updated payer information 
• This includes new portals identified and escalated to the Supervisor for enrollment/access 
• Completes group clean-up upon identification or by request of the Supervisor or Leadership 
• *When Applicable* Call sheets Investigated By a specific team member will own the call sheet when it is in the Pending Approval (PA) queue 
• SD call sheets in PA are required to be completed before leaving for the day 
• NSD call sheets in PA are expected to be completed within 48 hours from the submitted date 
• Comfortable auditing newer team members upon request from the Supervisor
• Provides the highest level of customer service when representing eBlu Solutions (this applies to both internal and external partners)
• Exhibit critical thinking and investigative behaviors throughout the workday
• Utilization of all resources and tools (ie. OneNote, Portals, Google, etc.)
• Responsible for monitoring Cost Parsing Rules to ensure they are "on" if not, notify the Supervisor upon identification
• Exhibits the skillset to investigate groups built and recognize group discrepancies
• Update OneNote timely and accordingly or upon request from the Supervisor or Leadership 
• Timely communication with Payer Research Specialists for Medical Policy updates or PA Form automation. Exhibits the ability to understand and interpret EOB's & SOBs (ie. interpreting claims)
• Exhibits the ability to pivot between queues and support team members with questions throughout the day
• Actively working during work hours and report in the office on assigned days for shoulder to shoulder and all-in days
• All other tasks or assignments provided by Supervisor or leadership

Requirements

• High school Diploma or GED required; some college preferred
• 3-5 years’ experience in a health plan, facility, healthcare provider office, or pharmaceutical industry preferred)
• Working knowledge of reimbursement (i.e. benefit investigation, prior authorization, pre-certification, letters of medical necessity) preferred
• Knowledge of Medical Terminology preferred
• Working knowledge of drug reimbursement issues preferred
• Understanding of Health Plan Medical Policies and Prior Authorization Criteria preferred
• Knowledge of HCPCS, CPT, and ICD-10 coding preferred
• Proficient computer skills (position requires strong data entry experience, and must be comfortable with cloud-based web applications)
• Proficient in Microsoft office applications
• Professional Communication (written/verbal) 
• Clear, concise, and can articulate information efficiently 
• Attention to detail/accuracy 
• Organized and self-led 
• Time Management Skills 
• Strong prioritization skills 
• Mastery of the eBlu Portal and Payer Portals 
• Proficient in making benefits calls with guided call scripts 
• Understanding of Buy & Bill 
• Proficient technical skillset 
• Robust research and investigative skillset 
• Ability to retain information and training to produce high-performance results 

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.