Clinical Financial Case Mgr

The Ohio State University

7d • Onsite

About The Position

The PAC is responsible for follow-up on all prior authorization submissions and communication to the clinical team regarding the status of the prior authorization. They are also responsible for identifying trends in denials and providing education to clinical staff to reduce these denials along with gathering all clinical and supporting evidence. The PAC would benefit from a strong understanding of the disease implications, use of various treatment modalities, and expected outcomes. The PAC’s responsibilities include understanding and verifying benefits, obtaining prior authorization for outpatient medications, and collecting and interpreting patient clinical information. In addition, the PAC may be required during the authorization process to contact patients/families to gather information. Communication will also be necessary with physicians, payers, and other customer groups. PACs must be able to navigate the electronic medical record system to obtain and interpret pertinent medical information for the prior authorization process, including the determination of whether a medication is being used within or outside FDA labeling, relevant lab results, genetic testing and pathology. PACs will solve routine customer problems related to prior authorization work.

Requirements

• Active OH Board of Pharmacy Certified Pharmacy Technician required
• Experience with Windows, Excel, Access, and Intranet/internet navigation tools
• Knowledge of Medicare and commercial insurance reimbursement is expected along with general knowledge of ICD-10 codes
• Excellent verbal and written communication skills required
• Proficient in the use of computer-based research and medical record documentation required
• Ability to satisfy expectations of onsite work at an OSUWMC team location facility

Nice To Haves

• Associate or bachelor’s degree is preferred.
• Minimum of 3 years’ pharmacy experience preferred.
• Strong understanding of the disease implications, use of various treatment modalities, and expected outcomes.

Responsibilities

• Follow-up on all prior authorization submissions
• Communication to the clinical team regarding the status of the prior authorization
• Identifying trends in denials and providing education to clinical staff to reduce these denials
• Gathering all clinical and supporting evidence
• Understanding and verifying benefits
• Obtaining prior authorization for outpatient medications
• Collecting and interpreting patient clinical information
• Contacting patients/families to gather information
• Communication with physicians, payers, and other customer groups
• Navigating the electronic medical record system to obtain and interpret pertinent medical information for the prior authorization process
• Solving routine customer problems related to prior authorization work

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees