Medical Insurance Benefits Manager

CSI Companies•Plano, TX

6d•$85,000 - $95,000•Onsite

About The Position

At CSI Pharmacy (CSI), we are on a mission to provide Specialty Pharmacy services to patients with chronic and rare illnesses in need of complex care. CSI is a rapidly growing national Specialty Pharmacy. Whether you work directly with patients or behind the scenes in support of the business and its employees, you will use your expertise, experience, and skills to support our patients and our mission. The Medical Insurance Benefits Manager is an acting manager role that is responsible for maintaining the Medical Insurance Benefits Team and ensuring work is distributed carefully throughout the team. This position is responsible for the training, process development, and monitoring the insurance verification queue. This position is not responsible for any work on active patients, only patients in the referral process. This position must be able to collect data, establish facts, draw conclusions, and identify and solve problems.

Requirements

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

Nice To Haves

College or technical college preferred
Minimum 3 years of Team Lead or Management experience highly preferred
Medical and pharmacy insurance experience preferred
Knowledge of Medicare, Medicaid, and third-party vendors

Responsibilities

Manages Medical Insurance Benefits Specialists, that focus on referrals, to ensure processes are followed, staff complete workload as assigned, and training is completed
Development of training guides for Medical Insurance Specialists
Works with Referral Coordinators to provide assistance and answer medical insurance questions on any patients in the referral process.
Assist insurance department with continuation authorizations
Run benefits & gather all necessary documents to submit authorizations for commercial insurance
Check status daily on pending authorizations
Conduct patient chart audits
Maintain current files and other records in accordance with CSI Pharmacy instructions and requirements.
Make outreach efforts to insurances, patient, specialist office and care team as set forth by department guideline and clinical priorities.
Correlate with Intake personnel and assist with work duties
Interacts collaboratively with clinical staff and insurance
Provide accurate data entry of referral or authorization information into the electronic medical record.
Send complete information to patient’s insurance (when applicable) and referring specialist to coordinate referral.
Complete and submit 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.
Utilize 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.