Clinical Financial Case Manager Senior Pharmacy Denial Management (S4) at The Ohio State University

, , United States -

Full Time

Start Date

Immediate

Expiry Date

06 Jun, 26

Salary

0.0

Posted On

08 Mar, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Clinical Reviews, Denial Management, Appeal Submission, Appeal Tracking, Liaison, Third-Party Payors, Electronic Medical Records, Clinical Guidelines, Process Improvement, Staff Mentoring, Provider Collaboration, Payor Collaboration, Revenue Integrity, Medicare Knowledge, Commercial Insurance Reimbursement, ICD-10 Codes

Industry

Higher Education

Description

Screen reader users may encounter difficulty with this site. For assistance with applying, please contact hr-accessibleapplication@osu.edu. If you have questions while submitting an application, please review these frequently asked questions. Current Employees and Students: If you are currently employed or enrolled as a student at The Ohio State University, please log in to Workday to use the internal application process. Welcome to The Ohio State University's career site. We invite you to apply to positions of interest. In order to ensure your application is complete, you must complete the following: Ensure you have all necessary documents available when starting the application process. You can review the additional job description section on postings for documents that may be required. Prior to submitting your application, please review and update (if necessary) the information in your candidate profile as it will transfer to your application. Job Title: Clinical Financial Case Manager Senior Pharmacy Denial Management (S4) Department: James | Pharmacy Administration Scope/Position Summary The Clinical Financial Case Manager – Senior Pharmacy Denial Management is responsible for managing complex pharmacy-related medication denials across the health system. Key duties include conducting comprehensive clinical reviews, submitting and tracking appeals, and ensuring timely resolution in alignment with payer guidelines. This role serves as a liaison between the pharmacy department and third-party payors, advocating for optimal reimbursement and resolving technical denials. The position requires expertise in navigating electronic medical records, interpreting clinical and billing data, and applying recognized clinical guidelines to support appeals. Additional responsibilities include leading process improvement initiatives, mentoring staff, and collaborating with providers, payors, and internal teams to enhance patient access and protect pharmacy revenue integrity. Minimum Qualifications Minimum 6 years’ experience or relevant healthcare experience required. Bachelor’s degree required. Advanced degree in healthcare or similar field preferred. Experience in finance, insurance, insurance appeals, medication and medical terminology desired. Ability to communicate clearly with others and experience with Microsoft Office, electronic medical records, and intranet/internet navigation tools. Must be highly organized, detail oriented, and able to manage multiple projects at a time. Advanced knowledge of Medicare and commercial insurance reimbursement expected along with strong knowledge of ICD-10 codes. Knowledge in drug billing/coding and reimbursement desired. Excellent verbal and written communication skills desired. Advanced competency in the use of computer-based research and medical record documentation desired Additional Information: Location: Remote Location 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. Thank you for your interest in positions at The Ohio State University and Wexner Medical Center. Once you have applied, the most updated information on the status of your application can be found by visiting the Candidate Home section of this site. Please view your submitted applications by logging in and reviewing your status. For answers to additional questions please review the frequently asked questions. The university is an equal opportunity employer, including veterans and disability. Each day, Buckeyes across the state and around the world make a lasting impact. The Ohio State University sets the stage for academic achievement and innovation. It's where friendships are forged, tradition is brought to life and a better global community is built. Our mission is as clear today as it was 150 years ago: to illuminate a pathway to education, research and health care that creates vibrant futures. Faculty and staff build the incomparable Buckeye spirit through collaboration, a strong sense of community and an unwavering commitment to excellence. Our strength comes from our ability to bring out the best in people and learn from Buckeyes of all backgrounds, passions and talents. Ohio State is a dynamic community where opportunity thrives and individuals transform themselves and their world. Positions are available in countless fields and specialties. Ohio State is a top-20 public university, and its Ohio State Wexner Medical Center is one of America’s leading academic health centers. Eligible Ohio State employees receive comprehensive benefits packages, including medical, dental and vision insurance, tuition assistance for employees and their dependents, and state or alternative retirement options with competitive employer contributions. Become a Buckeye and contribute to an incredible legacy that serves to guide our future and shape a better tomorrow.

Responsibilities

The Senior Pharmacy Denial Management Case Manager is responsible for managing complex pharmacy-related medication denials across the health system by conducting clinical reviews and managing appeals for timely resolution. This role involves acting as a liaison to third-party payors to advocate for optimal reimbursement and resolve technical denials.