Clinical Financial Case Management Specialist 2

Clinical Financial Case Management Specialist 2 page is loaded Clinical Financial Case Management Specialist 2 Apply locations Medical Center Campus time type Full time posted on Posted 30+ Days Ago job requisition id R128201 Screen reader users may encounter difficulty with this site. For assistance with applying, please contact View email address on click.appcast.io . If you have questions while submitting an application, please review these frequently asked questions . Current Employees and Students: If you are currently employed or enrolled as a student at The Ohio State University, please l og in to Workday to use the internal application process. Welcome to The Ohio State University's career site. We invite you to apply to positions of interest. In order to ensure your application is complete, you must complete the following: Ensure you have all necessary documents available when starting the application process. You can review the additional job description section on postings for documents that may be required. Prior to submitting your application, please review and update (if necessary) the information in your candidate profile as it will transfer to your application. Job Title: Clinical Financial Case Management Specialist 2 Department: James | Pharmacy Administration Scope of Position Use of clinical knowledge for the management of complex James Cancer Center ambulatory medical necessity denials through the appeals process. Providing scientific evidence to support cutting edge therapies, and diagnostic services. Providing clinical education to payers regarding current standard of care treatment and other frequently denied services as applicable. Identifying trends, and areas for needed clinical education, to decrease denials where applicable. Submission of 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. Position Summary Goals and objectives include: 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. Facilitates education as needed to ensure compliance, and support strong business practices for the clinical areas. Minimum Qualifications Associate Degree in Nursing preferred. Minimum of 3 years oncology experience preferred. Experience with Windows, Excel, Access, and Intranet/internet navigation tools. Minimum of 3 years experience in the field of oncology with solid clinical skills and current clinical practices required. 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. Excellent verbal and written skills required. Proficient in the use of computer based research and medical record documentation required. Use of computer based billing systems, and databases a plus. Additional Information: Location: Doan Hall (0089) Position Type: Regular Scheduled Hours: 40 Shift: First Shift Final candidates are subject to successful completion of a background check. A drug screen or physical may be required during the post offer process. 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The Ohio State University sets the stage for academic achievement and innovation. It's where friendships are forged, tradition is brought to life and a better global community is built. Our mission is as clear today as it was 150 years ago: to illuminate a pathway to education, research and health care that creates vibrant futures. Faculty and staff build the incomparable Buckeye spirit through collaboration, a strong sense of community and an unwavering commitment to excellence. Our strength comes from our ability to bring out the best in people and learn from Buckeyes of all backgrounds, passions and talents. Ohio State is a dynamic community where opportunity thrives and individuals transform themselves and their world. Positions are available in countless fields and specialties. Ohio State is a top-20 public university, and its Ohio State Wexner Medical Center is one of America’s leading academic health centers. 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