Medical Insurance Benefits Manager

Kaplan International; Plano (TX); On-site; USD 85,000 - 95,000; Full time

Job summary

CSI Pharmacy in Plano, TX is seeking a Medical Insurance Benefits Manager to lead our Benefits team and ensure efficient handling of referrals and insurance authorizations. The role focuses on training, process development, and monitoring the insurance verification queue, without direct patient work in active cases.

The ideal candidate has 5+ years in pharmacy/healthcare, 3+ years in management, and strong MS Office skills.

Qualifications

• High school diploma or GED required; college preferred for advancement.
• Minimum 5 years in pharmacy or healthcare environment.
• Minimum 3 years of Team Lead or Management experience preferred.
• Medical and pharmacy insurance experience preferred; Medicare/Medicaid knowledge helps.

Responsibilities

• Manages Medical Insurance Benefits Specialists and ensures workload is distributed and training completed.
• Develops training guides for Medical Insurance Specialists.
• Supports Referral Coordinators with insurance questions for patients in the referral process.
• Coordinates authorizations and submits required insurance documents.

Skills

Team Leadership

Analytical skills

Microsoft Office Suite

Multi-tasking

Education

High School Diploma or GED

College or technical college preferred

Tools

Excel

Outlook

Teams

Word

Job description

Job Title and Location

Job Title Medical Insurance Benefits Manager Location CSI Plano TX Additional Location(s) Employee Type Employee Working Hours Per Week 40

Job Description

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.

Summary

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.

Compensation and Schedule

Compensation Range: $85,000 - $95,000 (DOE)

Schedule: (On-Site) Monday - Friday, 8:30am - 5:00pm

Location: 5340 Legacy Dr., Plano, TX

Essential Duties and 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.

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 accommodations may be made to enable individuals with disabilities to perform the essential functions.
• 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
• Education and/or Experience High School Diploma or equivalent GED is required, at minimum.
• College or technical college preferred
• Minimum 5 years in pharmacy or healthcare environment
• 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

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 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 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 20 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 accommodations 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 by automobile and be exposed to changing weather conditions.

Comments

This description is intended to describe the essential job functions, the general supplemental functions, and the essential requirements for the performance of this job. It is not an exhaustive list of all duties, responsibilities, and requirements of a person so classified. Other functions may be assigned, and management retains the right to add or change the duties at any time.

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.

Equal Opportunity Employer

CSI Pharmacy is an Equal Opportunity Employer. CSI PharmacyWe’re a nationwide specialty pharmacy, founded by pharmacists and dedicated to providing services for patients with chronic and rare illnesses that require complex care. We are invested in improving the health, and the lives, of the people we serve by offering expert clinicians, passionate advocates, committed healthcare partners, and strategic reimbursement experts. Our goal is to optimize patient outcomes while treating patients as if they were members of our family. Every employee – from those who work with our patients in the field, to those who support them in administrative and office roles – is valued, respected, and encouraged to grow. CSI Pharmacy is an Equal Opportunity EmployerPrivacy Statement Providing complex therapies to patients in the home setting is a long-term commitment for our CSI Pharmacy staff. Not only do we work hard to ensure all of our patients receive the highest level of care and comfort, but we also love getting to know our patients personally and sharing their sense of success when their condition improves. Here are some of the folks you may meet on your journey with us.