The Ohio State University Wexner Medical Center · 1 month ago
Clinical Finance Case Management Specialist
Columbus, OH
Full-time
Onsite
Mid, Senior Level
3+ years expThe Ohio State University Wexner Medical Center 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 while supporting the revenue cycle management process.
Health CareHospitalMedical
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
Minimum of 3 years oncology experience expected
Minimum of 3 years experience in the field of oncology with solid clinical skills and current clinical practices required
Experience with Windows, Excel, Access, and Intranet/internet navigation tools
Knowledge of Medicare and commercial insurance reimbursement expected
Excellent verbal and written skills required
Proficient in the use of computer based research and medical record documentation required
Preferred
Associate or Bachelor Degree in Nursing preferred
Strong knowledge of ICD-10-CM, HCPCs, and CPT coding preferred
Experience in physician practice, and/or utilization review a plus
Use of computer based billing systems, and databases a plus
Company
The Ohio State University Wexner Medical Center
The Ohio State University Wexner Medical Center is personalizing health care to meet the needs of each patient. It is a sub-organization of The Ohio State University.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Emile Daoud
Chief, Cardiac Electrophysiology Section
Recent News
2025-10-09
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