• Job Description

  Req#: JR255183
  Job Title
  CSI CareTend Payer Specialist (H)
  
  Location
  Remote/Nationwide, USA
  
  Additional Location(s)
  
  Employee Type
  Employee
  
  Working Hours Per Week
  40
  
  Job Description
  
  Essential Duties and Responsibilities
  
  Include the following. Other duties may be assigned, as necessary.
  
  Payer & Pricing Configuration
  
  • 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.
  
  Revenue Integrity & Auditing
  
  • 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.
  
  Enrollment & EDI Setup
  
  • Enroll payers in Waystar for EDI, ERA, claims, eligibility, and denial management.
  • Assist with EFT enrollments and payer application processes.
  
  Documentation & Communication
  
  • 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.
  
  Compliance & General
  
  • 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.
  Qualification Requirements
  
  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 accommodation may be made to enable individuals with disabilities to perform the essential functions.
  
  • 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.
  Education and/or Experience
  
  • High School Diploma or GED required.
  • Associate or bachelor's degree in healthcare concentration or related field preferred.
  • 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.
  Physical Demands
  
  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 accommodation 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 listen. The employee regularly is required to stand, walk, sit, climb stairs, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
  
  The employee frequently lifts and/or moves up to 50 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
  Work Environment
  
  The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
  This job generally operates in a clerical office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines. While performing the duties of this position, the employee may travel occasionally and be exposed to changing weather conditions.
  
  NOTICE: Successful completion of a drug screen prior to employment is part of our background process, which includes medical and recreational marijuana.
  
  By supplying your phone number, you agree to receive communication via phone or text.
  
  CSI Pharmacy is an Equal Opportunity Employer

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