You haven't searched anything yet.
Position Summary
Responsible for follow-up on rejected and denied claims using evidence based support and other documentation as needed. Works with Medical Information Management to ensure proper ICD9 and CPT4 coding are performed on each claim. Responsible for identifying trends in denials and providing education to clinical staff and managed care payers to reduce these denials; Gather all clinical and supporting evidence and submit to payers for pre-determination of off-label services and/or complex procedures and treatment modalities; Communicate status of pre-determination request to stakeholders; Educate clinical and other staff on off-label definitions and policies and requirements for authorization on other complex cancer treatment modalities; Provide clinical support to non-clinical pre-certification staff as needed. Must have a strong understanding of the disease implications, use of various treatment modalities, and expected outcomes.
Organizational Expectations
Minimum Qualifications
For Hire Required:
For Hire Preferred:
Job Relationships
Supervisory Responsibility: None
Contacts: Utilization Management, Patient Access, Patient Accounting and Finance staffs, IS, operational departmental managers and cost center contacts, physicians and administrative staff of other hospital entities as well as OSUMC administration.
Responsible to: Manager, Revenue Cycle Clinical Support
Physical/Visual/Mental Requirements
While performing the duties of this job, the employee must be able to:
Work Environment
The work environment involves everyday risks or discomforts which requires normal safety precautions typical of such places as offices and meeting rooms (i.e. use of safe work practices, avoidance of trips and falls, and observance of fire regulations and traffic signs).
There is a possibility of working from home in this position. Must have high speed internet. Requirements are to have satisfactory performance appraisals, not be in corrective action, be self-motivated and organized. Work from home is at managements discretion. Staff are expected to report in house for once a month meetings and others as assigned.
Note: The above statements are intended to describe the essential functions and related requirements of persons assigned to this job. They are not intended as an exhaustive list of all job duties, responsibilities, and requirements.
Full Time
Hospital
$69k-87k (estimate)
03/29/2024
05/28/2024
wexnermedical.osu.edu
COLUMBUS, OH
15,000 - 50,000
1834
Private
MICHAEL V DRAKE
$3B - $5B
Hospital