Medical Insurance Benefits Specialist

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 Specialist will be responsible to perform benefit investigation and obtain prior authorization for both new and existing patients to process patient prescription orders in a timely manner while demonstrating excellent customer service to patients, healthcare professionals and insurance carriers. The Benefits 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.

Plano, TX

Schedule: Monday – Friday; 8:30am – 5:00pm (100% On‑Site)
Pay Range: $18 - $23/hour (DOE)

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

• Assists insurance department with continuation authorizations
• Runs benefits & gathers all necessary documents to submit authorizations for commercial insurance
• Checks status daily on pending authorizations
• Conducts patient chart audits
• Maintains current files and other records in accordance with CSI Pharmacy instructions and requirements.
• Makes outreach efforts to insurances, patients, specialist offices and care teams as set forth by department guidelines and clinical priorities.
• Coordinates with Intake personnel and assists 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.
• Complies 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 home‑care patients and to home‑care referral sources.
• Attends and participates in conventions, trade shows and in‑services relating to IV therapy as appropriate.
• Consistently represents the company in a professional manner.
• Maintains effective working relationships and cooperates 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.
• Performs other duties and responsibilities as assigned.

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.

• Provides 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

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

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…