Inside Higher Ed · 2 weeks ago
Clinical Financial Case Mgr
Columbus, OH
Full-time
Onsite
Mid Level
3+ years expThe Ohio State University is a prominent educational institution, and they are seeking a Clinical Financial Case Manager. This role involves managing prior authorization processes, educating clinical staff to reduce denial trends, and ensuring effective communication among patients, physicians, and payers.
Digital MediaEducationHigher EducationJournalismRecruiting
Responsibilities
Follow-up on all prior authorization submissions and communication to the clinical team regarding the status of the prior authorization
Identifying trends in denials and providing education to clinical staff to reduce these denials
Gathering all clinical and supporting evidence
Understanding and verifying benefits
Obtaining prior authorization for outpatient medications
Collecting and interpreting patient clinical information
Contacting patients/families to gather information during the authorization process
Communication with physicians, payers, and other customer groups
Navigating the electronic medical record system to obtain and interpret pertinent medical information for the prior authorization process
Determining whether a medication is being used within or outside FDA labeling
Solving routine customer problems related to prior authorization work
Qualification
Required
Active OH Board of Pharmacy Certified Pharmacy Technician
Experience with Windows, Excel, Access, and Intranet/internet navigation tools
Knowledge of Medicare and commercial insurance reimbursement
General knowledge of ICD-10 codes
Excellent verbal and written communication skills
Proficient in the use of computer-based research and medical record documentation
Ability to satisfy expectations of onsite work at an OSUWMC team location facility
Preferred
associate or bachelor's degree
Minimum of 3 years' pharmacy experience
Company
Inside Higher Ed
Inside Higher Ed is the online source for news, opinion, and jobs related to higher education.
51-200 employees
Funding
Current Stage
Growth StageTotal Funding
unknown2022-01-10Acquired
2006-08-31Series Unknown
Leadership Team
Stephanie Shweiki
Director, Foundation Partnerships
Recent News
Research & Development World
2025-05-03
Business Standard India
2025-04-11
Company data provided by crunchbase