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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 management's 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.
Additional Information:Location:Remote LocationPosition Type:RegularScheduled Hours:40Shift:First ShiftFinal candidates are subject to successful completion of a background check. A drug screen or physical may be required during the post offer process.Thank you for your interest in positions at The Ohio State University and Wexner Medical Center. Once you have applied, the most updated information on the status of your application can be found by visiting the Candidate Home section 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 Ohio State University is an equal opportunity employer.
All qualified applicants will receive consideration for employment without regard to age, ancestry, color, disability, ethnicity, gender identity or expression, genetic information, HIV/AIDS status, military status, national origin, race, religion, sex, gender, sexual orientation, pregnancy, protected veteran status, or any other basis under the law.
Applicants are encouraged to complete and submit the Equal Employment Identification form.
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