Inside Higher Ed · 1 day ago
Clinical Financial Case Manager II- IRP
Columbus, OH
Part-time
Onsite
Mid Level
3+ years expThe Ohio State University is a leading institution in higher education, and they are seeking a Clinical Financial Case Manager II for their Pharmacy Administration department. This role is responsible for managing rejected and denied claims, ensuring proper coding, and providing education to clinical staff to reduce 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
Required
Minimum of 3 years oncology experience
Minimum of 3 years experience in the field of oncology with solid clinical skills and current clinical practices
Experience with Windows, Excel, Access, and Intranet/internet navigation tools
Knowledge of Medicare and commercial insurance reimbursement
Excellent verbal and written skills
Proficient in the use of computer based research and medical record documentation
Preferred
Associate or Bachelor Degree in Nursing
Strong knowledge of ICD-10-CM, HCPCs, and CPT coding
Experience in physician practice, and/or utilization review
Use of computer based billing systems, and databases
Company
Inside Higher Ed
Inside Higher Ed is the online source for news, opinion, and jobs related to higher education.
51-200 employees
Funding
Current Stage
Growth StageTotal Funding
unknown2022-01-10Acquired
2006-08-31Series Unknown
Leadership Team
Stephanie Shweiki
Director, Foundation Partnerships
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