Clinical Finance Case Management Specialist 2

The Ohio State University, Main Campus

Clinical Finance Case Management Specialist managing complex oncology billing and claim denials at James Cancer Hospital. Collaborating with clinicians to improve revenue and compliance processes in healthcare.

Posted 6/23/2026full-timeJames Cancer Hospital • Ohio • 🇺🇸 United StatesMid-LevelSeniorWebsite

About the role

Key responsibilities & impact

Use of clinical knowledge for the management of complex James Cancer Center ambulatory medical necessity denials through the appeals process.
Providing scientific evidence to support cutting edge therapies, and diagnostic services.
Providing clinical education to payers regarding current standard of care treatment and other frequently denied services as applicable.
Identifying trends, and areas for needed clinical education, to decrease denials where applicable.
Submission of pre-determination requests proactively supporting clinicians in efforts to identify areas where loss of revenue is at risk to mitigate that risk.
Provide support to the CBO Medicare billing area in the form of correcting billing errors before the bill is sent to the payer.
Provide clinical support for the review of clinical data to access current policies and processes impacting revenue.
Provide coverage support to the pre-certification area when clinical intervention is required.

Requirements

What you’ll need

Associate Degree in Nursing preferred.
Minimum of 3 years oncology experience preferred.
Experience with Windows, Excel, Access, and Intranet/internet navigation tools.
Minimum of 3 years experience in the field of oncology with solid clinical skills and current clinical practices required.
Experience in physician practice, and/or utilization review a plus.
Knowledge of Medicare and commercial insurance reimbursement preferred.
Strong knowledge of ICD-9-CM, HCPCs, and CPT coding preferred.
Excellent verbal and written skills required.
Proficient in the use of computer based research and medical record documentation required.
Use of computer based billing systems, and databases a plus.

Benefits

Comp & perks

Medical, dental and vision coverage, with Ohio State paying a significant portion of the cost.
Paid time off, including sick and vacation time and 11 holidays.
State retirement plan or an alternative retirement plan, both with generous employer contributions.

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

clinical knowledgeoncology experienceICD-9-CM codingHCPCs codingCPT codingclinical skillsutilization reviewbilling error correctionpre-certification supportmedical record documentation

Soft Skills

verbal communicationwritten communicationclinical educationtrend identificationsupport provision

Certifications

Associate Degree in Nursing