Clinical Finance Case Management Specialist 2

The Ohio State University

13d • Onsite

About The Position

This position utilizes clinical knowledge for the management of complex James Cancer Center ambulatory medical necessity denials through the appeals process. It involves providing scientific evidence to support cutting-edge therapies and diagnostic services, as well as clinical education to payers regarding current standard of care treatment and other frequently denied services. The role also focuses on identifying trends and areas for needed clinical education to decrease denials, submitting pre-determination requests, and proactively supporting clinicians in identifying and mitigating risks of revenue loss. Additionally, the specialist will provide support to the CBO Medicare billing area by correcting billing errors before bills are sent to payers, offer clinical support for reviewing clinical data to assess current policies and processes impacting revenue, and provide coverage support to the pre-certification area when clinical intervention is required.

Requirements

• 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.
• Excellent verbal and written skills required.
• Proficient in the use of computer based research and medical record documentation required.

Nice To Haves

• Associate Degree in Nursing preferred.
• Minimum of 3 years oncology experience preferred.
• Experience in physician practice, and/or utilization review a plus.
• Knowledge of Medicare and commercial insurance reimbursement preferred.
• Strong knowledge of ICD-9-CM, HCPCs, and CPT coding preferred.
• Use of computer based billing systems, and databases a plus.

Responsibilities

• Use clinical knowledge for the management of complex James Cancer Center ambulatory medical necessity denials through the appeals process.
• Provide scientific evidence to support cutting-edge therapies and diagnostic services.
• Provide clinical education to payers regarding current standard of care treatment and other frequently denied services.
• Identify trends and areas for needed clinical education to decrease denials.
• Submit pre-determination requests proactively supporting clinicians in efforts to identify areas where loss of revenue is at risk to mitigate that risk.
• Provide support to the CBO Medicare billing area in the form of correcting billing errors before the bill is sent to the payer.
• Provide clinical support for the review of clinical data to access current policies and processes impacting revenue.
• Provide coverage support to the pre-certification area when clinical intervention is required.
• Continue to foster effective working relationships with Nurse Managers, clinical staff, and CBO departments providing education and clinical support as appropriate.
• Pursue hospital reimbursement related to patient services, and other special projects that will decrease loss of revenue, and support the Mission of the James.
• Facilitate education as needed to ensure compliance, and support strong business practices for the clinical areas.

Benefits

• Medical, dental and vision coverage, with Ohio State paying a significant portion of the cost.
• Paid time off, including sick and vacation time and 11 holidays.
• State retirement plan or an alternative retirement plan, both with generous employer contributions.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree