Clinical Financial Case Mgr - RN
RemoteUnited States
Job Summary
Implement and support the philosophy, mission, values, standards, policies, and procedures of The Ohio State University Wexner Medical Center within the multidisciplinary team. Secure complex pre-authorizations and prevent or appeal clinical denials by utilizing clinical knowledge to interpret medical necessity guidelines and determine appropriate levels of care based on documented information. Become a Subject Matter Expert for assigned payers and governmental requirements such as RAC, MAC, and QIO audits while maintaining awareness of state and national healthcare trends. This role requires proficiency in clinical operations, revenue management, coding, and utilizing multiple applications including IHIS and payer websites. Candidates must be versatile to adapt to changing payer rules and capable of troubleshooting complex billing scenarios. Final candidates are subject to a background check, and a drug screen or physical may be required.
Required Qualifications
- Bachelor's degree in nursing
- current license
- Minimum of 3 years clinical care experience
- 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
- Must be able to read, understand and interpret a payer remit, denial/remark codes, and expected reimbursement to determine the cost effectiveness of completing an appeal
- Must be versatile, flexible, and very adaptable to change
- Must be able to troubleshoot, problem solve, continuously learn, be highly independent, self-motivated and have an elevated level of interpretive skills and the ability to work closely with departments such as Legal, Medical Information Management, Physician groups and the Business Office
- Final candidates are subject to successful completion of a background check
- A drug screen or physical may be required during the post offer process
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