CSI PDP Insurance Benefits Specialist

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Summary

The PDP Insurance Billing Specialist will be responsible to perform benefit investigation and obtain prior authorization for both new and existing patients to process and bill patient prescription orders in a timely manner while demonstrating excellent customer service to patients, healthcare professionals and insurance carriers. The Billing Specialist will assist in keying information into the system, including diagnosis, demographics, payor info, etc. This position must be able to collect data, establish facts, draw conclusions, and identify and solve problems.

Essential Duties and Responsibilities

include the following. Other duties may be assigned, as necessary.

• Assists with patient billing
• Assists insurance department with continuation authorizations
• Runs benefits & gathers all necessary documents to submit authorizations for commercial/PDP insurance
• Checks status daily on pending authorizations
• Conducts patient chart audits accordingly
• Maintains current files and other records in accordance with CSI Pharmacy instructions and requirements.
• Makes outreach efforts to insurances, patient, specialist office and care team as set forth by department guideline and clinical priorities.
• Correlates with key personnel and assist with work duties
• Interacts collaboratively with clinical staff and insurance
• Provides accurate data entry of referral or authorization information into the electronic medical record.
• Sends complete information to patient's insurance (when applicable) and referring specialist to coordinate referral.
• Completes and submits all required reports in a timely manner.
• Comply with all company policies, instructions, and directives for the fulfillment of company objectives and maximum profitable sales.
• Utilizes operating systems and tools to help manage patient therapy and refill compliance.

• Provides high quality services to the home-care patient and the home-care referral source.
• Attends and participates in conventions, trade shows and in-services relating to IV therapy.
• Consistently represents the company in a professional manner.
• Maintain effective working relationship and cooperate with all personnel in the Company.
• Adheres to the Company's compliance requirements as stated in the policy and procedure manual and all other related policies.
• Perform other duties and responsibilities as assigned.

Qualification Requirements

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Provide the highest level of professionalism, responsiveness, and communication to build and maintain the maximum customer base possible.
• Must possess the ability to multi-task and frequently change direction.
• Analytical and problem-solving skills
• Attention to detail
• Experience working in Microsoft Office, specifically Excel, Outlook, Teams, and Word

Education and/or Experience

• High School Diploma or equivalent GED is required, at minimum. College or technical college preferred
• Minimum one year in pharmacy or healthcare environment
• Knowledge of Medicare, Medicaid, and third-party vendors

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, climb stairs, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

The employee frequently lifts and/or moves up to 20 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This job generally operates in a clerical office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines. While performing the duties of this position, the employee may travel by automobile and be exposed to changing weather conditions.

Comments

This description is intended to describe the essential job functions, the general supplemental functions, and the essential requirements for the performance of this job. It is not an exhaustive list of all duties, responsibilities, and requirements of a person so classified. Other functions may be assigned, and management retains the right to add or change the duties at any time.

NOTICE: Successful completion of a drug screen prior to employment is part of our background process, which includes medical and recreational marijuana.

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By submitting your application, you are confirming that you are legally authorized to work in the United States.

JR# JR235864