The Ohio State University Wexner Medical Center · 1 month ago
Clinical Financial Case Mgr
Columbus, OH
Full-time
Onsite
Mid Level
3+ years expThe Ohio State University Wexner Medical Center is seeking a Clinical Financial Case Manager. The role involves managing prior authorization submissions, communicating with the clinical team, and educating staff to reduce denials, while also gathering clinical evidence and understanding patient benefits.
Health CareHospitalMedical
Responsibilities
Follow-up on all prior authorization submissions and communication to the clinical team regarding the status of the prior authorization
Identify trends in denials and provide education to clinical staff to reduce these denials along with gathering all clinical and supporting evidence
Understand and verify benefits, obtain prior authorization for outpatient medications, and collect and interpret patient clinical information
Contact patients/families to gather information during the authorization process
Communicate with physicians, payers, and other customer groups
Navigate the electronic medical record system to obtain and interpret pertinent medical information for the prior authorization process
Determine whether a medication is being used within or outside FDA labeling, relevant lab results, genetic testing and pathology
Solve routine customer problems related to prior authorization work
Qualification
Required
Active OH Board of Pharmacy Certified Pharmacy Technician required
Excellent verbal and written communication skills required
Proficient in the use of computer-based research and medical record documentation required
Ability to satisfy expectations of onsite work at an OSUWMC team location facility
Preferred
Associate or bachelor's degree is preferred
Minimum of 3 years' pharmacy experience preferred
Experience with Windows, Excel, Access, and Intranet/internet navigation tools
Knowledge of Medicare and commercial insurance reimbursement is expected
General knowledge of ICD-10 codes
Company
The Ohio State University Wexner Medical Center
The Ohio State University Wexner Medical Center is personalizing health care to meet the needs of each patient. It is a sub-organization of The Ohio State University.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Emile Daoud
Chief, Cardiac Electrophysiology Section
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