Senior Clinical Financial Case Manager – Pharmacy Denial Management
The Ohio State University, Main Campus
full-time
Posted on:
Location Type: Hybrid
Location: University Hospital • Ohio • United States
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Job Level
About the role
- Managing complex pharmacy-related medication denials across the health system.
- Conducting comprehensive clinical reviews, submitting and tracking appeals, and ensuring timely resolution in alignment with payer guidelines.
- Serving as a liaison between the pharmacy department and third-party payors, advocating for optimal reimbursement and resolving technical denials.
- Leading process improvement initiatives, mentoring staff, and collaborating with providers, payors, and internal teams to enhance patient access and protect pharmacy revenue integrity.
Requirements
- 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
Benefits
- Medical, dental and vision coverage, with Ohio State paying a significant portion of the cost.
- Paid time off, including sick and vacation time and 11 holidays.
- State retirement plan or an alternative retirement plan, both with generous employer contributions.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
clinical reviewsappeals trackingMedicare reimbursementcommercial insurance reimbursementICD-10 codesdrug billingcodingmedical record documentationfinancial analysisinsurance appeals
Soft Skills
communicationorganizationdetail orientedproject managementmentoringcollaborationadvocacyleadershipproblem-solvinginterpersonal skills