[Hiring] Clinical Financial Case Management Representative @The Ohio State University

Role Description

The Senior Reimbursement Analyst position is responsible for intervention and follow-up on accounts that require clinical interpretation and analysis along the revenue cycle. Primary focus will be assuring precertification for outpatient procedures, and accounts that are rejected from the payers for a variety of reasons. This position requires a high level of clinical knowledge and the ability to work proficiently in the Integrated Health Information Systems (IHIS).

• Provide support through education and communication to other departments such as MIM, PCRMs, Physicians, Nurse Practitioners, PAs, and other clinical personnel.
• Identify trends and offer suggestions for process improvement to support avoidance of and recoupment of lost revenue.

Position Summary:

• Responsible for follow-up on rejected and denied claims using evidence-based support and other documentation as needed.
• Work with Medical Information Management to ensure proper ICD10 and CPT4 coding are performed on each claim.
• Identify trends in denials and provide education to clinical staff and managed care payers to reduce these denials.
• Gather all clinical and supporting evidence and submit to payers for pre-determination of off-label services and/or complex procedures and treatment modalities.
• Communicate status of pre-determination request to stakeholders.
• Educate clinical and other staff on off-label definitions and policies and requirements for authorization on other complex cancer treatment modalities.
• Provide clinical support to non-clinical pre-certification staff as needed.
• Must have a strong understanding of the disease implications, use of various treatment modalities, and expected outcomes.

Qualifications

• Bachelor's degree or equivalent experience.
• 2 years of relevant experience required.
• 2-4 years of relevant experience preferred.

Requirements

• Final candidates are subject to successful completion of a background check.
• A drug screen or physical may be required during the post-offer process.

Benefits

• Remote Location
• Intermittent Position Type
• Scheduled Hours: 0.2
• Shift: First Shift