Clinical Financial Case Manager

1 week ago


Columbus, Ohio, United States Ohio State University Wexner Medical Center Full time
Job Summary

As a Clinical Financial Case Manager at the Ohio State University Wexner Medical Center, you will play a critical role in ensuring the financial operations of our clinical programs are running smoothly. This position requires strong clinical knowledge and financial acumen to manage the complex process of coordinating insurance verification and prior authorization of outpatient medications. You will provide evidence to support cutting-edge therapies and educate payers on current standard of care treatments. Additionally, you will identify trends and areas for needed clinical education to decrease denials where applicable.

Responsibilities

Coordinate insurance verification and prior authorization of outpatient medications
Provide evidence to support cutting-edge therapies
Educate payers on current standard of care treatments
Identify trends and areas for needed clinical education
Submit test claims to proactively support clinicians in efforts to identify areas where risk of denial is high
Understand and verify benefits and obtain prior authorization for outpatient medications
Contact patients/families to ascertain additional demographic, financial, and insurance information
Utilize the electronic medical record system to obtain pertinent medical information for prior authorization process
Solve complex customer problems
Evaluate and solve complex issues/problems
Communicate and consult with the clinical team

Requirements

Bachelor's degree in Nursing, Pharmaceutical Sciences, or similar clinical healthcare field
At least 1 year of clinical experience, preferably in 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
Proficient in the use of computer-based research and medical record documentation
Experience in interpreting insurance benefit information and completing prior authorization process preferred

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