CSI CareTend Payer Specialist (H)

CSI Companies

7d•Remote

About The Position

This role is responsible for maintaining and updating payer configurations, managing payer profiles, and ensuring accurate revenue recognition through the management of contract pricing. The Payer Specialist will also assist with revenue integrity, auditing, enrollment, and EDI setup. Additionally, the role involves creating documentation, facilitating communication, and supporting revenue cycle staff. Compliance with HIPAA and company values is essential, along with participation in staff meetings and professional development.

Requirements

Provide the highest level of professionalism, responsiveness, and communication skills.
Effective time management skills and the ability to manage multiple tasks and adapt to changing priorities.
Demonstrated experience in customer service and satisfaction evaluation.
Ability to work effectively with colleagues as team members and to communicate effectively.
Strong analytical and problem-solving abilities.
Excellent verbal and written communication skills.
Self-motivated and able to work independently.
Working knowledge of basic medical terminology is required.
Competence in Microsoft Office required, including Excel, Outlook, and Word.
High School Diploma or GED required.
Minimum 5–7 years of experience in home infusion, specialty pharmacy, or healthcare setting.
Demonstrated experience working with major payers including Medicare, Medicaid, PBM, and commercial insurance.
Working proficiency in billing platform CareTend or CPR+, and Waystar.

Nice To Haves

Associate or bachelor’s degree in healthcare concentration or related field preferred.

Responsibilities

Maintain and update payer configurations in CareTend, including billing rules, per diem rules, and portal information.
Add and manage payer profiles in CareTend (contact, billing, and portal details), including new contracted payers received from the Managed Care team.
Manage and update the payer contract pricing sheet and pricing files, ensuring accurate revenue recognition.
Maintain the payer scrub board for accuracy and regular pricing updates.
Assist in weekly revenue SOX report auditing to identify billing and pricing discrepancies.
Monitor and report on pricing changes that impact revenue.
Surface root causes of recurring discrepancies and partner with Audit & Integrity on corrective action.
Enroll payers in Waystar for EDI, ERA, claims, eligibility, and denial management.
Assist with EFT enrollments and payer application processes.
Create and maintain payer instruction sheets for both new and existing contracts.
Upload payer instructions into CareTend and the Monday.com board.
Facilitate communication between Billing, Collections, and Management around changes to contract pricing in CareTend.
Support Revenue Cycle staff on payer and pricing issues as they arise.
Ensure compliance with HIPAA and maintain strict confidentiality of payer and patient data.
Adhere to CSI Pharmacy's Core Values and Core Competencies.
Participate in staff meetings, special projects, and ongoing professional development.