Clinical Financial Case Mgr

Scope/Position Summary

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 PACs 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.

Minimum Qualifications

For Hire: Active OH Board of Pharmacy Certified Pharmacy Technician required, associate or bachelors degree is preferred. Experience with Windows, Excel, Access, and Intranet/internet navigation tools. Minimum of 3 years pharmacy experience preferred. 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.