Clinical Financial Case Management Representative – IRP

Job not on LinkedIn

🔥 14 hours ago

🇺🇸 United States – Remote

⏱ Part Time

🟢 Junior

🟡 Mid-level

💸 Financial Planning and Analysis (FP&A)

👻 Ghost score 14%

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• Open for 1 day.
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• No salary listed.

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The Ohio State University, Main Campus

WebsiteLinkedInAll Job Openings

1 - 10 employees

Founded 1870

📚 Education

Education

The Ohio State University, Main Campus is a public research university located in Columbus, Ohio. It offers a comprehensive education with a wide array of undergraduate, graduate, and professional programs. The university is engaged in numerous research initiatives and partnerships, providing opportunities for students, faculty, and industry partners to collaborate. Ohio State promotes a vibrant student life with various academic, recreational, and wellness services to support student needs. It also emphasizes community involvement and leadership development, fostering an inclusive environment on its multiple campuses across Ohio.

📋 Description

• Intervene and follow up on accounts requiring clinical interpretation and revenue-cycle analysis • Assure precertification for outpatient procedures • Follow up on rejected and denied claims using evidence-based support and documentation • Work with Medical Information Management to ensure proper ICD10 and CPT4 coding • Identify denial trends and educate clinical staff and managed care payers to reduce denials • Gather clinical and supporting evidence for payer pre-determination of off-label services and complex procedures or treatment modalities • Communicate pre-determination request status to stakeholders • Educate clinical and other staff on off-label definitions, policies, and authorization requirements • Provide clinical support to non-clinical pre-certification staff • Suggest process improvements to avoid and recoup lost revenue • Support departments including MIM, PCRMs, physicians, nurse practitioners, PAs, and other clinical personnel

🎯 Requirements

• Bachelor's degree or equivalent experience • 2 years of relevant experience required • 2–4 years of relevant experience preferred • High level of clinical knowledge • Proficiency using Integrated Health Information Systems (IHIS) • Strong understanding of disease implications, treatment modalities, and expected outcomes • Ability to complete a background check • Drug screen or physical may be required during the post-offer process

🏖️ Benefits

• Equal opportunity employer, including veterans and disability • Potential drug screen or physical during the post-offer process

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