The Ohio State University Wexner Medical Center
Clinical Finance Case Management Specialist
The Ohio State University Wexner Medical Center, Columbus, Ohio, United States, 43224
Clinical Finance Case Management Specialist
3 days ago – Be among the first 25 applicants.
Get AI-powered advice on this job and more exclusive features.
Job Description Scope of Position: The Senior Reimbursement Analyst position is responsible for intervention and follow‑up on accounts that require clinical interpretation and analysis along the revenue cycle. Primary focus will be assuring precertification for outpatient procedures and accounts that are rejected by payers for a variety of reasons. This position requires a high level of clinical knowledge and the ability to work proficiently in the Integrated Health Information Systems (IHIS). In addition, the position provides support through education and communication to other departments such as MIM, PCRMs, Physicians, Nurse Practitioners, PAs, and other clinical personnel. The individual must be able to identify trends and offer suggestions for process improvement to support avoidance of and recoupment of lost revenue.
Position Summary Responsible for follow‑up on rejected and denied claims using evidence‑based support and other documentation as needed. Works with Medical Information Management to ensure proper ICD‑10 and CPT‑4 coding are performed on each claim. Identifies trends in denials and provides education to clinical staff and managed‑care payers to reduce these denials. Gathers all clinical and supporting evidence and submits it to payers for pre‑determination of off‑label services and/or complex procedures and treatment modalities. Communicates status of pre‑determination requests to stakeholders, educates clinical and other staff on off‑label definitions and policies and requirements for authorization for other complex cancer treatment modalities, and provides clinical support to non‑clinical pre‑certification staff as needed. Must have a strong understanding of disease implications, the use of various treatment modalities, and expected outcomes.
Minimum Qualifications Associate or Bachelor degree in Nursing preferred. Minimum of 3 years oncology experience expected. Experience with Windows, Excel, Access, and intranet/internet navigation tools. Minimum of 3 years experience in the field of oncology with solid clinical skills and current clinical practices required. Experience in physician practice and/or utilization review is a plus. Knowledge of Medicare and commercial insurance reimbursement expected. Strong knowledge of ICD‑10‑CM, HCPCS, and CPT coding preferred. Excellent verbal and written skills required. Proficient in computer‑based research and medical record documentation. Use of computer‑based billing systems and databases is a plus.
Thank you for your interest in working at Ohio State.
Seniority Level Mid‑Senior level
Employment Type Full‑time
Job Function Health Care Provider
Industries Hospitals and Health Care
The university is an equal opportunity employer, including veterans and disability. Final candidates are subject to successful completion of a background check. A drug screen or physical may be required during the post‑offer process.
#J-18808-Ljbffr
Get AI-powered advice on this job and more exclusive features.
Job Description Scope of Position: The Senior Reimbursement Analyst position is responsible for intervention and follow‑up on accounts that require clinical interpretation and analysis along the revenue cycle. Primary focus will be assuring precertification for outpatient procedures and accounts that are rejected by payers for a variety of reasons. This position requires a high level of clinical knowledge and the ability to work proficiently in the Integrated Health Information Systems (IHIS). In addition, the position provides support through education and communication to other departments such as MIM, PCRMs, Physicians, Nurse Practitioners, PAs, and other clinical personnel. The individual must be able to identify trends and offer suggestions for process improvement to support avoidance of and recoupment of lost revenue.
Position Summary Responsible for follow‑up on rejected and denied claims using evidence‑based support and other documentation as needed. Works with Medical Information Management to ensure proper ICD‑10 and CPT‑4 coding are performed on each claim. Identifies trends in denials and provides education to clinical staff and managed‑care payers to reduce these denials. Gathers all clinical and supporting evidence and submits it to payers for pre‑determination of off‑label services and/or complex procedures and treatment modalities. Communicates status of pre‑determination requests to stakeholders, educates clinical and other staff on off‑label definitions and policies and requirements for authorization for other complex cancer treatment modalities, and provides clinical support to non‑clinical pre‑certification staff as needed. Must have a strong understanding of disease implications, the use of various treatment modalities, and expected outcomes.
Minimum Qualifications Associate or Bachelor degree in Nursing preferred. Minimum of 3 years oncology experience expected. Experience with Windows, Excel, Access, and intranet/internet navigation tools. Minimum of 3 years experience in the field of oncology with solid clinical skills and current clinical practices required. Experience in physician practice and/or utilization review is a plus. Knowledge of Medicare and commercial insurance reimbursement expected. Strong knowledge of ICD‑10‑CM, HCPCS, and CPT coding preferred. Excellent verbal and written skills required. Proficient in computer‑based research and medical record documentation. Use of computer‑based billing systems and databases is a plus.
Thank you for your interest in working at Ohio State.
Seniority Level Mid‑Senior level
Employment Type Full‑time
Job Function Health Care Provider
Industries Hospitals and Health Care
The university is an equal opportunity employer, including veterans and disability. Final candidates are subject to successful completion of a background check. A drug screen or physical may be required during the post‑offer process.
#J-18808-Ljbffr