Inside Higher Ed
Clinical Finance Case Management Specialist
Inside Higher Ed, Columbus, Ohio, United States, 43224
Clinical Finance Case Management Specialist
Job Title: Clinical Finance Case Management Specialist
Department: James Pharmacy Administration
Location: James Outpatient Care (1043)
Position Type: Regular
Scheduled Hours: 40
Shift: First Shift
Responsibilities
Follow up on rejected and denied claims using evidence‑based support and documentation.
Work with Medical Information Management to ensure proper ICD‑10 and CPT coding on each claim.
Identify trends in denials and provide education to clinical staff and managed care payers to reduce denials.
Gather clinical and supporting evidence and submit to payers for pre‑determination of off‑label services or complex procedures.
Communicate status of pre‑determination requests to stakeholders.
Educate clinical and other staff on off‑label definitions, policies, and requirements for authorization on complex cancer treatment modalities.
Provide clinical support to non‑clinical pre‑certification staff as needed.
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.
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 the use of computer‑based research and medical record documentation.
Experience in physician practice, and/or utilization review a plus.
Additional Information Position Type: Regular Scheduled Hours: 40 Shift: First Shift
Final candidates are subject to successful completion of a background check. A drug screen or physical may be required during the post‑offer process.
The university is an equal opportunity employer, including veterans and disabled individuals. As required by Ohio Revised Code section 3345.0216, Ohio State will: educate students by means of free, open and rigorous intellectual inquiry to seek the truth; equip students with the opportunity to develop intellectual skills to reach their own, informed conclusions; not require, favor, disfavor or prohibit speech or lawful assembly; create a community dedicated to an ethic of civil and free inquiry, which respects the autonomy of each member, supports individual capacities for growth and tolerates differences in opinion; treat all faculty, staff and students as individuals, hold them to equal standards and provide equality of opportunity with regard to race, ethnicity, religion, sex, sexual orientation, gender identity or gender expression.
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Responsibilities
Follow up on rejected and denied claims using evidence‑based support and documentation.
Work with Medical Information Management to ensure proper ICD‑10 and CPT coding on each claim.
Identify trends in denials and provide education to clinical staff and managed care payers to reduce denials.
Gather clinical and supporting evidence and submit to payers for pre‑determination of off‑label services or complex procedures.
Communicate status of pre‑determination requests to stakeholders.
Educate clinical and other staff on off‑label definitions, policies, and requirements for authorization on complex cancer treatment modalities.
Provide clinical support to non‑clinical pre‑certification staff as needed.
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.
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 the use of computer‑based research and medical record documentation.
Experience in physician practice, and/or utilization review a plus.
Additional Information Position Type: Regular Scheduled Hours: 40 Shift: First Shift
Final candidates are subject to successful completion of a background check. A drug screen or physical may be required during the post‑offer process.
The university is an equal opportunity employer, including veterans and disabled individuals. As required by Ohio Revised Code section 3345.0216, Ohio State will: educate students by means of free, open and rigorous intellectual inquiry to seek the truth; equip students with the opportunity to develop intellectual skills to reach their own, informed conclusions; not require, favor, disfavor or prohibit speech or lawful assembly; create a community dedicated to an ethic of civil and free inquiry, which respects the autonomy of each member, supports individual capacities for growth and tolerates differences in opinion; treat all faculty, staff and students as individuals, hold them to equal standards and provide equality of opportunity with regard to race, ethnicity, religion, sex, sexual orientation, gender identity or gender expression.
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