The Ohio State University Wexner Medical Center
Clinical Financial Case Mgr
The Ohio State University Wexner Medical Center, Columbus, Ohio, United States, 43224
Clinical Financial Case Mgr – The Ohio State University Wexner Medical Center
Senior Reimbursement Analyst position responsible for intervention and follow‑up on accounts that require clinical interpretation and analysis along the revenue cycle. Primary focus is to assure precertification for outpatient procedures and to handle accounts that are rejected by payers for various reasons. This role requires a high level of clinical knowledge, proficiency with Integrated Health Information Systems (IHIS), and strong communication to support other departments. Responsibilities: Follow‑up on rejected and denied claims using evidence‑based support and required documentation. Work with Medical Information Management to ensure proper ICD‑10 and CPT‑4 coding on each claim. Identify trends in denials and provide education to clinical staff and managed‑care payers to reduce these denials. Gather clinical and supporting evidence and submit to payers for pre‑determination of off‑label services and/or complex procedures. Communicate status of pre‑determination requests to stakeholders. Educate clinical and other staff on off‑label definitions and 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’s 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. Strong knowledge of ICD‑10‑CM, HCPCS, and CPT coding. Excellent verbal and written communication skills. Proficient in computer‑based research and medical record documentation. Final candidates are subject to successful completion of a background check and may be required to undergo a drug screen or physical examination during the post‑offer process. The university is an equal opportunity employer, including veterans and disability. Seniority Level
Mid‑Senior level Employment Type
Full‑time Job Function
Health Care Provider Industries
Hospitals and Health Care
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Senior Reimbursement Analyst position responsible for intervention and follow‑up on accounts that require clinical interpretation and analysis along the revenue cycle. Primary focus is to assure precertification for outpatient procedures and to handle accounts that are rejected by payers for various reasons. This role requires a high level of clinical knowledge, proficiency with Integrated Health Information Systems (IHIS), and strong communication to support other departments. Responsibilities: Follow‑up on rejected and denied claims using evidence‑based support and required documentation. Work with Medical Information Management to ensure proper ICD‑10 and CPT‑4 coding on each claim. Identify trends in denials and provide education to clinical staff and managed‑care payers to reduce these denials. Gather clinical and supporting evidence and submit to payers for pre‑determination of off‑label services and/or complex procedures. Communicate status of pre‑determination requests to stakeholders. Educate clinical and other staff on off‑label definitions and 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’s 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. Strong knowledge of ICD‑10‑CM, HCPCS, and CPT coding. Excellent verbal and written communication skills. Proficient in computer‑based research and medical record documentation. Final candidates are subject to successful completion of a background check and may be required to undergo a drug screen or physical examination during the post‑offer process. The university is an equal opportunity employer, including veterans and disability. Seniority Level
Mid‑Senior level Employment Type
Full‑time Job Function
Health Care Provider Industries
Hospitals and Health Care
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