The Ohio State University · 7 hours ago
Clinical Financial Case Management Specialist 2-1
University Hospital
Full-time
Onsite
Mid Level
3+ years expThe Ohio State University is a leading institution in healthcare education and services, and they are seeking a Clinical Financial Case Management Specialist. The role involves managing complex medical necessity denials, providing clinical education, and supporting revenue-related efforts within the James Cancer Center.
EducationHigher EducationUniversities
Responsibilities
Use of clinical knowledge for the management of complex James Cancer Center ambulatory medical necessity denials through the appeals process
Providing scientific evidence to support cutting edge therapies, and diagnostic services
Providing clinical education to payers regarding current standard of care treatment and other frequently denied services as applicable
Identifying trends, and areas for needed clinical education, to decrease denials where applicable
Submission of pre-determination requests proactively supporting clinicians in efforts to identify areas where loss of revenue is at risk to mitigate that risk
Provide support to the CBO Medicare billing area in the form of correcting billing errors before the bill is sent to the payer
Provide clinical support for the review of clinical data to access current policies and processes impacting revenue
Provide coverage support to the pre-certification area when clinical intervention is required
Continue to foster effective working relationships with Nurse Managers, clinical staff, and CBO departments providing education and clinical support as appropriate
Pursue hospital reimbursement related to patient services, and other special projects that will decrease loss of revenue, and support the Mission of the James
Facilitates education as needed to ensure compliance, and support strong business practices for the clinical areas
Qualification
Required
Minimum of 3 years experience in the field of oncology with solid clinical skills and current clinical practices
Excellent verbal and written skills
Proficient in the use of computer based research and medical record documentation
Preferred
Associate Degree in Nursing
Minimum of 3 years oncology experience
Knowledge of Medicare and commercial insurance reimbursement
Strong knowledge of ICD-9-CM, HCPCs, and CPT coding
Experience in physician practice, and/or utilization review
Experience with Windows, Excel, Access, and Intranet/internet navigation tools
Use of computer based billing systems, and databases
Company
The Ohio State University
The Ohio State University is a public research university based in Columbus, Ohio.
10001+ employees
H1B Sponsorship
The Ohio State University has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
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Trends of Total Sponsorships
2025 (311)
2024 (295)
2023 (236)
2022 (149)
2021 (111)
2020 (125)
Funding
Current Stage
Late StageTotal Funding
$52.28MKey Investors
AmeriCorps Public AlliesNational Safety CouncilFederal Aviation Administration
2024-07-09Grant· $0.81M
2024-04-29Grant
2024-03-05Grant· $0.35M
Leadership Team
Bill Diffenderffer
Director of Entrepreneurship
Nicole Kraft
Professor
Recent News
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2025-10-24
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