Job Title:
Clinical Financial Case Mgr
Job ID:
James Cancer Hospital/CCC
Pharmacy Patient Assistance
Full/Part Time:
FTE %:
Salary Range Min:
Salary Range Max:

Position summary

Clinical Financial Case Mgr (Job Opening 429305) - Scope of Position

The James Cancer Hospital is committed to improving access and service to customers. The Medication Assistance Advocate functions as an integral member of the health care team to reflect a culture of cooperation, enthusiasm and mutual respect. This position ensures the coordination of the insurance verification and prior authorization process for outpatient medications. This process includes assisting in defining pharmacy co-pay information, benefit limitations and coverage, important to both patient and physician planning as well as ensures the appropriate information for successful billing.

Position Summary

The Medication Assistance Advocate?s responsibilities include understanding and verifying benefits and obtaining prior authorization for outpatient medications. In addition, the advocate will at times contact patients/families in order to ascertain additional demographic, financial, and insurance information essential to the authorization processes while also informing patients of medication co-pays. Must be able to utilize the electronic medical record system to obtain pertinent medical information for prior authorization process. Will solve routine customer problems. Will communicate regularly with the physicians, physician offices and payers when limitations, restrictions, documentation requirements and etc. are needed for prior authorizations to take place. Must be able to evaluate complex issues and understand escalation procedures. Displays the highest level of customer service, attentiveness and consideration possible in all cases. Uses multiple system applications and customer service skills to facilitate optimal experience for the patient and successful first time billing for the hospital system.

Education and experience

Bachelor's Degree in Nursing, Pharmaceutical Sciences or similar clinical healthcare field and 1 year experience in clinical healthcare setting or physician?s practice or Bachelor's Degree in any field with 3 years experience in clinical healthcare setting or physician?s practice required. Registered Nurse preferred. Experience in interpreting insurance benefit information and completing prior authorization process preferred. Knowledge of medical terminology preferred. Experience with internet and internet navigational tools is very helpful. Excellent interpersonal skills especially communication, ability to work effectively with team desired. Must be highly organized, detail oriented, and able to manage multiple projects at a time. Must complete PTCB certification within 180 days of hire, unless current PTCB certificate or other healthcare licensure is in place upon hire.