The Ohio State University · 1 month ago
Clinical Finance Case Management Specialist
Columbus Campus
Full-time
Onsite
Mid Level
3+ years expThe Ohio State University is seeking a Clinical Finance Case Management Specialist. This role is responsible for follow-up on rejected and denied claims, ensuring proper coding, and providing education to clinical staff to reduce denials.
EducationHigher EducationUniversities
Responsibilities
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 ICD10 and CPT4 coding are performed on each claim
Responsible for identifying trends in denials and providing education to clinical staff and managed care payers to reduce these denials
Gather all clinical and supporting evidence and submit to payers for pre-determination of off-label services and/or complex procedures and treatment modalities
Communicate status of pre-determination request to stakeholders
Educate clinical and other staff on off-label definitions and policies and requirements for authorization on other complex cancer treatment modalities
Provide clinical support to non-clinical pre-certification staff as needed
Must have a strong understanding of the disease implications, use of various treatment modalities, and expected outcomes
Qualification
Required
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 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 the use of computer based research and medical record documentation required
Use of computer based billing systems, and databases a plus
Company
The Ohio State University
The Ohio State University is a public research university based in Columbus, Ohio.
10001+ employees
H1B Sponsorship
The Ohio State University has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (311)
2024 (295)
2023 (236)
2022 (149)
2021 (111)
2020 (125)
Funding
Current Stage
Late StageTotal Funding
$52.28MKey Investors
AmeriCorps Public AlliesNational Safety CouncilFederal Aviation Administration
2024-07-09Grant· $0.81M
2024-04-29Grant
2024-03-05Grant· $0.35M
Leadership Team
Bill Diffenderffer
Director of Entrepreneurship
Nicole Kraft
Professor
Recent News
Sports Business Journal
2025-10-24
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