Clinical Finance Case Management Specialist 2

Job Title: Clinical Finance Case Management Specialist 2 Department: James | Pharmacy Administration Scope of Position Use clinical knowledge for managing complex James Cancer Center ambulatory medical necessity denials through the appeals process, providing scientific evidence to support cutting‑edge therapies and diagnostic services. Provide clinical education to payers about current standard of care treatments and frequently denied services. Identify trends and areas for needed clinical education to reduce denials. Submit pre‑determination requests proactively to mitigate revenue loss. Correct billing errors before they are sent to payers, review clinical data for current policies impacting revenue, and support pre‑certification areas when clinical intervention is needed. Position Summary Build effective relationships with Nurse Managers, clinical staff, and CBO departments. Pursue hospital reimbursement related to patient services and special projects that reduce revenue loss while supporting the mission of James. Facilitate education to ensure compliance and promote strong business practices in 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 oncology with solid clinical skills and current clinical practices (required). Experience in physician practice and/or utilization review (plus). Knowledge of Medicare and commercial insurance reimbursement (preferred). Strong knowledge of ICD-9-CM, HCPCS, and CPT coding (preferred). Excellent verbal and written communication skills (required). Proficiency in computer‑based research and medical record documentation (required). Experience with computer‑based billing systems and databases (plus). Additional Information Location: James Cancer Hospital (0375). Position Type: Regular. Scheduled Hours: 40. Shift: First. The university is an equal opportunity employer, including veterans and disability. #J-18808-Ljbffr The Ohio State University