Job Description

Summary

The CareTend Payer Specialist plays a critical role in supporting the financial health of CSI Pharmacy by maintaining accurate payer and pricing for Federal, State and Commercial payers.   The Specialist will adhere to established policies and procedures and contribute to developing the best practices within the department.

Essential Duties and Responsibilities

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

• Comply with Company’s Core Values and Core Competencies
• Perform other duties as assigned by supervisor
• Maintain and update payer configurations in CareTend.
• Maintain and update pricing files, ensuring accurate revenue recognition.
• Add and manage payer profiles in CareTend, including contact, billing, and portal information.
• Ensure accurate setting up of billing and per diem rules.
• Manage and update the payer contract pricing sheet.
• Add and manage new contracted payer profiles received from the Managed Care Team.
• Assist in weekly revenue SOX report auditing to identify billing and pricing discrepancies.
• Facilitate communication between billing, collections, and upper management around changes made to contract pricing in Caretend.
• Support Revenue Cycle staff on payer and/or pricing issues.
• Monitor and report on pricing changes that impact revenue.
• Participate in staff meetings and ongoing professional development activities.
• Ensure compliance with HIPAA and maintain strict confidentiality.
• Support special projects and other duties as assigned.
• Enroll payers in Waystar for EDI, ERA, claims, eligibility, and denial management.
• Assist with EFT enrollments and payer application processes.
• Create and maintain payer instruction sheets for both new and existing contracts.
• Upload payer instructions into Caretend and Monday Board.
• Maintain payer scrub board for accuracy and regular pricing updates.

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.

By submitting your application, you are confirming that you are legally authorized to work in the United States.

JR# JR249260