The Ohio State University Wexner Medical Center · 13 hours ago
Clinical Financial Case Manager II- IRP
Columbus, OH
Part-time
Onsite
Mid Level
3+ years expThe Ohio State University Wexner Medical Center is seeking a Clinical Financial Case Manager II to manage the intervention and follow-up on accounts requiring clinical interpretation along the revenue cycle. This role involves ensuring precertification for outpatient procedures and addressing rejected claims, while providing support and education to various clinical departments.
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
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
Experience in physician practice, and/or utilization review a plus
Strong knowledge of ICD-10-CM, HCPCs, and CPT coding preferred
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
Company data provided by crunchbase