The university is an equal opportunity employer, including veterans and disability.
Clinical Financial Case Manager Senior Pharmacy Denial Management
Location
United States
Posted
10 days ago
Salary
Not specified
Job Description
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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