Location:

\nSaint James, LOUISIANA\n

Job Type:

\nFullTime\nScreen reader users may encounter difficulty with this site. For assistance with ing, please contact hr-accessibleapplicationosu . If you have questions while submitting an application, please review these frequently asked questions .\n

Current Employees and Students:

\nIf you are currently employed or enrolled as a student at The Ohio State University, please log in to Workday to use the internal application process.\nWelcome to The Ohio State University's career site. We invite you to to positions of interest. In order to ensure your application is complete, you must complete the following:\nEnsure 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.\nPrior 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:

\nClinical Finance Case Management Specialist 2\n

Department:

\nJames | Pharmacy Administration\nScope of Position\nUse 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.\nPosition Summary\nGoals 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.\nMinimum Qualifications\nAssociate 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.\n

Additional Information:

Location:

\nJames Cancer Hospital (0375)\n

Position Type:

\nRegular\n

Scheduled Hours:

\n40\n

Shift:

\nFirst Shift\nFinal candidates are subject to successful completion of a background check. A drug screen or physical may be required during the post offer process.\nThank you for your interest in positions at The Ohio State University and Wexner Medical Center. Once you have applied, the most updated information on the status of your application can be found by visiting the Candidate Home section of this site. Please view your submitted applications by logging in and reviewing your status. 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Clinical Finance Case Management Specialist 2