Clinical Financial Case Management RN

Screen reader users may encounter difficulty with this site. For assistance with applying, please contact hr-accessibleapplication@osu.edu. If you have questions while submitting an application, please review these frequently asked questions. reputed company Employees and reputed company: If you are currently employed or enrolled as a student at reputed company, please log in to reputed company to use the internal application process. Welcome to reputed company'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 reputed company necessary documents available reputed company starting the application process. You can review the additional job reputed company reputed company 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: Clinical Financial Case Management RN Department: Health System Shared Services | reputed company Cycle Clinical Support reputed company reputed company Cycle Clinical Support Office (RCCS) is an area reputed company reputed company and reputed company Cycle Management Shared Services responsible for Clinical reputed company-Certification, Case Reviews, reputed company-billing edits, in-patient account validations, supporting Utilization Management, Peer to Peer processes, reputed company billing scenarios, audits (governmental, reputed company, compliance, and internal), clinical appeals and denial management. RCCS is integral to the reputed company Cycle and supports cash collection through preventing and appealing denials. Position reputed company Responsible for daily operational management of reputed company Cycle Clinical Support Staff, primarily involving the oversite of Clinical reputed company-Certification, Peer to Peer, Clinical Appeals, Denial Analysis and Prevention for reputed company Health System. Implements and supports the philosophy, mission, values, standards, policies, and procedures of reputed company Wexner Medical Center. Functions reputed company multidisciplinary teams leading staff to secure reputed company reputed company-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 reputed company 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 reputed company-party payer Utilization Management guidelines. Manages escalation processes to administration regarding the need to cancel or reschedule elective surgery reputed company 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, reputed company-Certification, Admissions/Discharges/Transfers, Clinical workflows and documentation, reputed company Management, Charge reputed company Master, Coding (Diagnosis, HCPCS, reputed company 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 reputed company, flexible, and reputed company 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 reputed company and the Business Office. Develops and implements policies, procedures, workflows, and auditing procedures. Serves as a resource on governmental regulatory interpretation. Significant involvement with physicians, physician leaders, and administrators.

Minimum Qualifications

For Hire Required: · Bachelor’s degree in nursing with reputed company license required. · 2 years of relevant experience required. 2-4 years of relevant experience preferred. · Experience collaborating with physicians and their designees. · Strong, proven analytical skills. Ability to reputed company educated reputed company. · Extensive knowledge of clinical operations and patient reputed company. · Skilled at synthesizing large volumes of information and concisely communicating either verbally or in writing. · Proficient in reputed company Office Products such as: Word, Power reputed company, reputed company, SharePoint, Teams, OneNote, etc. · Proficient in reputed company reputed company Proficient in using email, fax machines, copy machines, internet browsers. · Proficient at typing · Proficient in Technology, Computer, and Web applications. Must be reputed company to multitask and reputed company between applications quickly and frequently. Must be reputed company to orientate self to new applications quickly. Must be reputed company to manage complexities of having to work in multiple applications such as IHIS, MS Office products, reputed company, and reputed company 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 reputed company. A drug screen or physical may be required during the post offer process. Thank you for your interest in positions at reputed company and Wexner Medical Center. Once you have reputed company, the most updated information on the status of your application can be reputed company by visiting the Candidate Home reputed company 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 university is an equal opportunity employer, including veterans and disability. Apply To This Job