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Clinical Financial Case Manager

1 month ago

Columbus, Ohio, United States Ohio State University Wexner Medical Center Full time

Job Summary:

The Clinical Financial Case Manager will utilize clinical knowledge to manage complex ambulatory medical necessity denials through the appeals process. This role will provide scientific evidence to support cutting-edge therapies and diagnostic services, as well as clinical education to payers regarding current standard of care treatment and frequently denied services.

Key Responsibilities:

  • Identify trends and areas for needed clinical education to decrease denials
  • Provide support to the CBO Medicare billing area in correcting billing errors
  • Review clinical data to access current policies and processes impacting revenue
  • Provide coverage support to the pre-certification area when clinical intervention is required

Requirements:

  • Associate Degree in Nursing preferred
  • Minimum of 3 years oncology experience
  • Experience with Windows, Excel, Access, and Intranet/internet navigation tools
  • Strong knowledge of ICD-9-CM, HCPCs, and CPT coding
  • Excellent verbal and written skills