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.

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

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.

Senior Clinical Financial Case Manager – Pharmacy Denial Management

Key skills