Clinical Financial Case Management Specialist

Clinical Financial Case Management Specialist 2

Position at The Ohio State University Wexner Medical Center. This role uses clinical knowledge for the management of complex James Cancer Center ambulatory medical necessity denials through the appeals process. Provides scientific evidence to support cutting edge therapies and diagnostic services. Identifies trends for needed clinical education to decrease denials. Submits pre-determination requests proactively supporting clinicians in efforts to identify areas where loss of revenue is at risk to mitigate that risk.

Provides support to the CBO Medicare billing area in the form of correcting billing errors before the bill is sent to the payer. Provides clinical review of data to assess current policies and processes impacting revenue. Provides coverage support to the pre-certification area when clinical intervention is required.

Goals and objectives include fostering 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.

• Associate Degree in Nursing preferred.
• Minimum of 3 years oncology experience preferred.
• 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 a plus.
• Knowledge of Medicare and commercial insurance reimbursement preferred.
• Strong knowledge of ICD-9-CM, HCPCS, and CPT coding preferred.
• Excellent verbal and written skills required.
• Proficient in the use of computer-based research and medical record documentation required.
• Use of computer-based billing systems, and databases a plus.

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. Screen reader users may encounter difficulty with the online application. For assistance with applying, please contact hr-accessible application. If you have questions while submitting an application, please review these frequently asked questions.