Clinical Financial Case Mgr
James Cancer Hospital/CCC
OSU Specialty Pharmacy
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Clinical Financial Case Mgr (Job Opening 457955) - Position Summary
This position uses clinical knowledge for the management of the complex process of coordinating insurance verification and prior authorization of outpatient medications; provides evidence to support cutting edge therapies; provides clinical education to payers regarding current standard of care treatment. Identifies trends, and areas for needed clinical education, to decrease denials where applicable.
Submission of test claims proactively supporting clinicians in efforts to identify areas where risk of denial is high to mitigate that risk. Responsibilities also include understanding and verifying benefits and obtaining prior authorization for outpatient medications. In addition, the position will at times contact patients/families in order to ascertain additional demographic, financial, and insurance information essential to the authorization processes while also informing patients of medication co-pays.
Having strong clinical knowledge, utilizes the electronic medical record system to obtain pertinent medical information for prior authorization process. Solves complex customer problems. Evaluates and solves complex issues/problems; communicates and consults with the clinical team.
Ohio State University Wexner Medical Center