Clinical Financial Case Manager - RN
New
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The Ohio State UniversityHealthcare revenue cycle
Source API remote eligibility restrictions: United StatesFull-TimeManager
Salary not disclosed
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Job Details
- Experience
- Minimum of 2 years clinical care experience
- Required Skills
- Microsoft Office
Requirements
- Hold a bachelor’s degree in nursing.
- Maintain a current nursing license.
- Have a minimum of 2 years of clinical care experience.
- Have experience collaborating with physicians and their designees.
- Demonstrate strong analytical skills and the ability to make educated decisions.
- Have extensive knowledge of clinical operations and patient flow.
- Synthesize large volumes of information and communicate concisely verbally or in writing.
- Be proficient with Microsoft Office products, including Word, PowerPoint, Excel, SharePoint, Teams, and OneNote.
- Be proficient with Adobe Professional.
- Use clinical and payer applications, including IHIS, 3M, and payer websites or applications; adapt quickly to new applications and multitask across systems.
Responsibilities
- Secure complex pre-authorizations and support clinical denial prevention and appeals.
- Interpret clinical documentation and medical necessity guidelines to determine appropriateness of services.
- Determine the appropriate level of care, including inpatient or observation.
- Become a subject matter expert for assigned payers and governmental payer requirements.
- Support payer reviews and audits, including RAC, MAC, and QIO audits.
- Read and interpret payer remits and denial or remark codes.
- Assess expected reimbursement and the cost effectiveness of completing an appeal.
- Work with Legal, Medical Information Management, physician groups, and the Business Office.
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