PDP Insurance Benefits Specialist

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.