Clinical Financial Case Mgr

The Ohio State University

Columbus, OH, US
Onsite
Prior authorization submission management
Electronic medical record navigation
Patient benefit verification skills
The role is responsible for following up on all prior authorization submissions and communicating status to the clinical team

Job Summary

  • The role is responsible for following up on all prior authorization submissions and communicating status to the clinical team.
  • Candidates must verify benefits, obtain prior authorizations for outpatient medications, and collect pertinent patient clinical information.
  • The position requires a strong understanding of disease implications, treatment modalities, and expected outcomes to reduce claim denials.

Matching Summary

The role is responsible for following up on all prior authorization submissions and communicating status to the clinical team.

Skills & Requirements

Must-have

  • Prior authorization submission management
  • Electronic medical record navigation
  • Patient benefit verification skills
  • Clinical evidence gathering
  • Insurance reimbursement knowledge

Nice-to-have

  • Strong verbal communication skills
  • Trend identification in denials
  • Disease implication understanding
  • Collaborative team environment
  • Educational delivery to staff

Key Requirements

  • Active OH Board of Pharmacy Certified Pharmacy Technician
  • Minimum 3 years pharmacy experience preferred
  • Associate or bachelor's degree preferred
  • Knowledge of Medicare and commercial insurance reimbursement
  • General knowledge of ICD-10 codes

Work Rights

Not specified

Tailored Resume

Cover Letter