Clinical Financial Case Manager

7 days ago


Columbus, Ohio, United States InsideHigherEd Full time
Job Title:

Clinical Financial Case Manager

Department:

James | Pharmacy Medication Access

Scope of Position:

The Clinical Financial Case Manager plays a critical role in ensuring the financial integrity of our clinical operations. This position is responsible for establishing and implementing financial controls, executing financial operations, and preparing and interpreting financial and operational reports to support strategic decisions.

Position Summary:

This position utilizes clinical knowledge to manage the complex process of coordinating insurance verification and prior authorization of outpatient medications. The Clinical Financial Case Manager provides evidence to support cutting-edge therapies, provides clinical education to payers regarding current standard of care treatment, and identifies trends and areas for needed clinical education to decrease denials where applicable. Additionally, this position proactively submits test claims to support clinicians in identifying areas where the risk of denial is high and mitigates that risk. Responsibilities also include understanding and verifying benefits and obtaining prior authorization for outpatient medications, as well as contacting patients/families to ascertain additional demographic, financial, and insurance information essential to the authorization processes.

Minimum Qualifications:
  • Bachelor Degree in Nursing, Pharmaceutical Sciences, or similar clinical healthcare field required
  • At least 1 year of clinical experience required, preferably in the field of oncology and/or pharmacy
  • Experience in physician practice and/or utilization review a plus
  • Knowledge of Medicare and commercial insurance reimbursement desired
  • Strong knowledge of medical and pharmaceutical terminology highly desired
  • Strong knowledge of ICD-9-CM, HCPCs, and CPT coding preferred
  • Excellent verbal and written skills required
  • Proficient in the use of computer-based research and medical record documentation required
  • Experience in interpreting insurance benefit information and completing prior authorization process preferred
Additional Information:

Location: Ackerman Rd, 660 (0242)

Position Type: Regular

Scheduled Hours: 40

Shift: First Shift

Final candidates are subject to successful completion of a background check. A drug screen or physical may be required during the post-offer process.



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