Screen reader users may encounter difficulty with this site. For assistance with applying, please contact [email protected] . 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 log 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:
Manager 2, Clinical Finance Case Manager- The James
Department:
James | Precert and Financial Counseling
Position Summary
Responsible for daily operational management of Revenue Cycle Clinical Support Staff primarily involving the oversite of Clinical Pre-Certification Peer to Peer Clinical Appeals Denial Analysis and Prevention for The Ohio State University Health System. Implements and supports the philosophy mission values standards policies and procedures of The Ohio State University Wexner Medical Center. Functions within multidisciplinary teams leading staff to secure complex pre-authorizations and prevent/appeal clinical denials. The job duties require the utilization of clinical knowledge to interpret and apply medical necessity guidelines to determine appropriateness for services provided. Makes determinations on the appropriate level of care (Inpatient or Observation) based on the ability to read understand and interpret documented clinical information. Is a Subject Matter Experts (SME) for commercial and governmental payer requirements and audits such as RAC MAC QIO etc. Maintains an awareness of State and National Health care trends JCAHO CMS and third-party payer Utilization Management guidelines. Manages escalation processes to administration regarding the need to cancel or reschedule elective surgery when authorization is not secured along with escalations to Managed Care on payer denials.
Is a SME and leads team members in understanding critical components of Managed Care Scheduling Financial Counseling Pre-Certification Admissions/Discharges/Transfers Clinical workflows and documentation Revenue Management Charge Description Master Coding (Diagnosis HCPCS Revenue Codes Procedure Codes Modifiers etc.) Medical Information Management Release of Information Case Management Utilization Management Clinical Documentation Improvement Compliance Legal Finance Transplant Workflows Billing Follow Up Cash Posting and any other areas that maybe needed to understand how to secure authorizations and appeal/prevent denials. Guides staff on how to read understand and interpret a payer remit denial/remark codes and expected reimbursement to determine the cost effectiveness of completing an appeal. Is versatile flexible and very adaptable to change because the payer rules change constantly. Troubleshoots problem solves continuously learns is highly independent self-motivated and has an elevated level of interpretive skills with the ability to work closely with departments such as Legal Medical Information Management Physician groups and the Business Office. Develops and implements policies procedures workflows and auditing procedures. Serves as a resource on governmental regulatory interpretation. Significant involvement with physician’s physician leaders and administrators.
Scope of Position
Revenue Cycle Clinical Support Office (RCCS) is an area within Access and Revenue Cycle Management Shared Services responsible for Clinical Pre-Certification Case Reviews Pre-billing edits in-patient account validations supporting Utilization Management Peer to Peer processes complex billing scenarios audits (governmental commercial compliance and internal) clinical appeals and denial management. RCCS is integral to the Revenue Cycle and supports cash collection through preventing and appealing denials.
Minimum Qualifications for Hiring
- Bachelor’s degree in nursing with current license required.
- Minimum of 5 years clinical care experience caring for patients anticipating their needs and understanding the physician’s plan of care.
- Experience collaborating with physicians and their designees.
- Strong proven analytical skills. Ability to make educated decisions.
- Extensive knowledge of clinical operations and patient flow.
- Skilled at synthesizing large volumes of information and concisely communicating either verbally or in writing.
- Proficient in Microsoft Office Products such as: Word Power Point Excel SharePoint Teams OneNote etc.
- Proficient in Adobe Professional Proficient in using email fax machines copy machines internet browsers.
- Proficient at typing
- Proficient in Technology Computer and Web applications. Must be able to multitask and move between applications quickly and frequently. Must be able to orientate self to new applications quickly. Must be able to manage complexities of having to work in multiple applications such as IHIS MS Office products 3M and all payer websites/applications.
Additional Information:
Location:
Remote Location
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.
Thank 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. For answers to additional questions please review the frequently asked questions .
The Ohio State University is an equal opportunity employer.
All qualified applicants will receive consideration for employment without regard to age, ancestry, color, disability, ethnicity, gender identity or expression, genetic information, HIV/AIDS status, military status, national origin, race, religion, sex, gender, sexual orientation, pregnancy, protected veteran status, or any other basis under the law.
Applicants are encouraged to complete and submit the Equal Employment Identification form.
Similar Positions
-
Insurance Billing/Collections Assistant Ii Physicians Billing Service, University of Washington, United States, about 14 hours ago
Scheduled Hours 40 Position Summary Performs follow-up insurance billing and makes collections calls to patients. Includes verifying accuracy and completeness of claims and contacts insurance comp...
-
Insurance Billing/Collection Assistant Ii Physicians Billing Service, University of Washington, United States, 6 days ago
Scheduled Hours 40 Position Summary Responsible for reviewing and evaluating insurance filing order changes of past visits to retroactively apply coverage changes and bill appropriate insurance co...
-
Pre Certification Coordinator (Remote) Neurosurgery, University of Washington, United States, 20 days ago
Scheduled Hours 40 Position Summary Position performs varied professional services to ensure medical/surgical and diagnostic/ancillary services are accomplished in an efficient manner and that rei...
-
Rn Nurse Care Manager (Remote) Faculty Practice Plan, University of Washington, United States, about 14 hours ago
Scheduled Hours 40 Position Summary The Nurse Care Manager (NCM) is responsible for providing enhanced care coordination to patients attributed to WUSM value-based care agreements. Primary respons...
-
Billing/Scheduling Associate Ii (Remote) Medical Oncology, University of Washington, United States, 6 days ago
Scheduled Hours 40 Position Summary Obtains insurance information and referral forms and counsels patients on financial assistance over the phone. Schedules and registers patients over the phone ...
-
Prospect Strategy Analyst, University of Florida, United States, about 17 hours ago
Classification Title: Prospect Strategy Analyst II Job Description: The Prospect Strategy Analyst serves as a key partner to colleges/units with regard to prospect strategy, research, and analysis...