The Ohio State University Wexner Medical Center · 1 hour ago
Clinical Financial Case Management Specialist 2-1
Columbus, OH
Full-time
Onsite
Mid Level
3+ years expThe Ohio State University Wexner Medical Center is seeking a Clinical Financial Case Management Specialist to manage complex medical necessity denials at the James Cancer Center. The role involves providing clinical education to payers, identifying trends to reduce denials, and supporting billing processes to mitigate revenue loss.
Health CareHospitalMedical
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 required
Excellent verbal and written skills required
Proficient in the use of computer based research and medical record documentation required
Preferred
Associate Degree in Nursing preferred
Minimum of 3 years oncology experience preferred
Experience with Windows, Excel, Access, and Intranet/internet navigation tools
Experience in physician practice, and/or utilization review a plus
Knowledge of Medicare and commercial insurance reimbursement preferred
Strong knowledge of ICD-9-CM, HCPCs, and CPT coding preferred
Use of computer based billing systems, and databases a plus
Company
The Ohio State University Wexner Medical Center
The Ohio State University Wexner Medical Center is personalizing health care to meet the needs of each patient. It is a sub-organization of The Ohio State University.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Emile Daoud
Chief, Cardiac Electrophysiology Section
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