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Inside Higher Ed · 1 day ago

Clinical Finance Case Management Specialist

Columbus, OH

Full-time

Onsite

Mid Level

3+ years exp

Inside Higher Ed is associated with The Ohio State University, which is seeking a Clinical Finance Case Management Specialist. This role is responsible for managing and analyzing clinical claims, ensuring proper coding, and providing education to reduce claim denials.

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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

Oncology experienceICD-10-CM codingCPT codingClinical knowledgeMedicare reimbursementExcel proficiencyProcess improvementVerbal communicationWritten communication