Clinical Financial Case Mgr

The Ohio State University

Columbus, OH, US
Onsite
Prior authorization submissions
Identify trends in denials
Gather clinical and supporting evidence
The PAC is responsible for follow-up on all prior authorization submissions and communication to the clinical team regarding the status of the prior authorization

Job Summary

  • The PAC is responsible for follow-up on all prior authorization submissions and communication to the clinical team regarding the status of the prior authorization.
  • They are also responsible for identifying trends in denials and providing education to clinical staff to reduce these denials along with gathering all clinical and supporting evidence.
  • PACs must be able to navigate the electronic medical record system to obtain and interpret pertinent medical information for the prior authorization process.

Matching Summary

The PAC is responsible for follow-up on all prior authorization submissions and communication to the clinical team regarding the status of the prior authorization.

Skills & Requirements

Must-have

  • prior authorization submissions
  • identify trends in denials
  • gather clinical and supporting evidence
  • understanding and verifying benefits
  • obtain prior authorization
  • interpret patient clinical information
  • navigate electronic medical record system

Nice-to-have

  • strong understanding of disease implications
  • knowledge of treatment modalities
  • knowledge of expected outcomes

Key Requirements

  • Active OH Board of Pharmacy Certified Pharmacy Technician required
  • Associate or bachelor’s degree preferred
  • Minimum of 3 years’ pharmacy experience preferred
  • Knowledge of Medicare and commercial insurance reimbursement
  • General knowledge of ICD-10 codes
  • Excellent verbal and written communication skills
  • Proficient in computer-based research
  • Proficient in medical record documentation
  • Ability to satisfy expectations of onsite work

Work Rights

Not specified

Tailored Resume

Cover Letter