Senior Pharmacy Denial Manager

Job Summary

A company is looking for a Clinical Financial Case Manager Senior Pharmacy Denial Management (S4).

Key Responsibilities

• Manage complex pharmacy-related medication denials across the health system
• Conduct comprehensive clinical reviews, submit and track appeals, and ensure timely resolution
• Lead process improvement initiatives and mentor staff while collaborating with providers and payors

Required Qualifications

• Minimum 6 years of relevant healthcare experience required
• Bachelor's degree required; advanced degree in healthcare preferred
• Experience in finance, insurance, and medication terminology desired
• Advanced knowledge of Medicare and commercial insurance reimbursement expected
• Knowledge in drug billing/coding and reimbursement desired