Clinical Appeals Manager
The Ohio State University, Main Campus
full-time
Posted on:
Location Type: Remote
Location: Ohio • United States
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About the role
- Responsible for daily operational management of Revenue Cycle Clinical Support staff, primarily involving the oversight of clinical appeals and denial analysis, resolution, and prevention for The Ohio State University Health System.
- Implements and supports the philosophy, mission, values, standards, policies, and procedures of The Ohio State University Wexner Medical Center.
- Functions within multidisciplinary teams.
- Leads staff on analysis and resolution of a variety of administrative and clinically related third-party payer denials and drives denial prevention efforts.
- Provides thorough support for the escalation of inappropriately denied claims to payers and external entities.
- Partners with Managed Care to seek resolution and appropriate reimbursement.
- Conducts quality assurance reviews and continuous process improvement on work done by staff and helps drive increase recoveries while maintaining lower AR.
Requirements
- Bachelor’s degree in nursing with current license required, advanced degree preferred.
- Minimum of 5 years clinical care experience, caring for patients, anticipating their needs, and understanding the physician’s plan of care.
- Minimum of 8 years denials and appeals experience.
- Five years of management experience in denials and appeals.
- Experience collaborating with physicians and their designees.
- Strong, proven analytical skills.
- Extensive knowledge of clinical operations and patient flow.
- 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.
Benefits
- Medical insurance
- Dental insurance
- Vision insurance
- Tuition assistance for employees and their dependents
- State or alternative retirement options with competitive employer contributions
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
clinical appealsdenial analysisresolutionpreventionquality assuranceprocess improvementclinical operationspatient flowanalytical skillsmanagement
Soft skills
collaborationleadershipcommunication
Certifications
Bachelor’s degree in nursingcurrent nursing license