Medical Insurance Benefits Specialist

$37,440 - $41,600/Yr

Csi Pharmacy - Plano, TX

Full-time - Entry Level

Plano, TX

Health and Personal Care Retailers

About the position

The Medical Insurance Benefits Specialist at CSI Pharmacy is responsible for performing benefit investigations and obtaining prior authorizations for patients to ensure timely processing of prescription orders. This role emphasizes excellent customer service and requires effective collaboration with patients, healthcare professionals, and insurance carriers. The specialist will also manage data entry and maintain accurate records while adhering to company policies and compliance requirements.

Responsibilities

• Perform benefit investigations and obtain prior authorizations for new and existing patients.
• Assist the insurance department with continuation authorizations.
• Run benefits and gather necessary documents for authorization submissions.
• Check status daily on pending authorizations.
• Conduct patient chart audits and maintain current files in accordance with company requirements.
• Make outreach efforts to insurances, patients, specialist offices, and care teams.
• Coordinate with Intake personnel and assist with work duties.
• Interact collaboratively with clinical staff and insurance providers.
• Provide accurate data entry of referral or authorization information into the electronic medical record.
• Send complete information to patient's insurance and referring specialist to coordinate referrals.
• Complete and submit all required reports in a timely manner.
• Utilize operating systems and tools to manage patient therapy and refill compliance.
• Provide high-quality services to home-care patients and referral sources.
• Attend conventions, trade shows, and in-services related to IV therapy as appropriate.
• Represent the company in a professional manner and maintain effective working relationships with all personnel.

Requirements

• High School Diploma or equivalent GED is required; college or technical college preferred.
• Minimum one year of experience in a pharmacy or healthcare environment.
• Knowledge of Medicare, Medicaid, and third-party vendors.
• Experience working in Microsoft Office, specifically Excel, Outlook, Teams, and Word.
• Strong analytical and problem-solving skills.
• Attention to detail and ability to multi-task.

Benefits

• Health insurance
• 401(k)