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The Ohio State University logo
The Ohio State University

The university is an equal opportunity employer, including veterans and disability.

Clinical Financial Case Manager Senior Pharmacy Denial Management

Medical Billing and CodingMedical Billing and CodingOtherRemoteTeam 51-200

Location

United States

Posted

105 days ago

Salary

0

No structured requirement data.

Job Description

Clinical Financial Case Manager Senior Pharmacy Denial Management

The Ohio State University

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Clinical Financial Case Manager – Senior Pharmacy Denial Management is responsible for managing complex pharmacy-related medication denials across the health system. - Conduct comprehensive clinical reviews - Submit and track appeals - Ensure timely resolution in alignment with payer guidelines - Serve as a liaison between the pharmacy department and third-party payors - Advocate for optimal reimbursement and resolve technical denials - Lead process improvement initiatives - Mentor staff - Collaborate with providers, payors, and internal teams to enhance patient access and protect pharmacy revenue integrity 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 - Experience with Microsoft Office, electronic medical records, and intranet/internet navigation tools - Highly organized and detail oriented - Able to manage multiple projects at a time - Advanced knowledge of Medicare and commercial insurance reimbursement expected - 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 Requirements - Final candidates are subject to successful completion of a background check - A drug screen or physical may be required during the post offer process Company Description The university is an equal opportunity employer, including veterans and disability.

Job 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
  • Experience with Microsoft Office, electronic medical records, and intranet/internet navigation tools
  • Highly organized and detail oriented
  • Able to manage multiple projects at a time
  • Advanced knowledge of Medicare and commercial insurance reimbursement expected
  • 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
  • Final candidates are subject to successful completion of a background check
  • A drug screen or physical may be required during the post offer process

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Cotiviti logo

Coder 1/HCC Risk Adjustment

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Enabling a high-quality and viable healthcare system

OtherRemoteTeam 5,001-10,000H1B Sponsor

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United States
$21 - $26 / hour
Job Closed

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OtherRemoteTeam 10,001+Since 1898H1B Sponsor

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United States
$29 - $44 / hour
Job Closed
Mayo Clinic logo

Hospital Inpatient Coder II - Remote

Mayo Clinic

Headquartered in Rochester, Minnesota, Mayo Clinic is a nonprofit medical institution ranked first in more specialties than all other hospitals in America. The

The HB IP Coder reviews, interprets, and translates provider medical diagnostic and procedural documentation into appropriate codes following hospital inpatient claims and reporting requirements. The HB Inpatient Coder initiates provider queries as needed to support accurate and comprehensive code assignment. Why Mayo Clinic Mayo Clinic is top-ranked in more specialties than any other care provider according to U.S. News & World Report. As we work together to put the needs of the patient first, we are also dedicated to our employees, investing in competitive compensation and comprehensive benefit plans – to take care of you and your family, now and in the future. And with continuing education and advancement opportunities at every turn, you can build a long, successful career with Mayo Clinic. Benefits Highlights - Medical: Multiple plan options. - Dental: Delta Dental or reimbursement account for flexible coverage. - Vision: Affordable plan with national network. - Pre-Tax Savings: HSA and FSAs for eligible expenses. - Retirement: Competitive retirement package to secure your future. Just as our reputation has spread beyond our Minnesota roots, so have our locations. Today, our employees are located at our three major campuses in Phoenix/Scottsdale, Arizona, Jacksonville, Florida, Rochester, Minnesota, and at Mayo Clinic Health System campuses throughout Midwestern communities, and at our international locations. Each Mayo Clinic location is a special place where our employees thrive in both their work and personal lives. Learn more about what each unique Mayo Clinic campus has to offer, and where your best fit is. Equal Opportunity All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, protected veteran status or disability status. Learn more about the "EOE is the Law". Mayo Clinic participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization.

United States
$29 - $43 / hour
Job Closed