Clinical Financial Case Manager

Job Summary

To support revenue cycle operations, the part-time Clinical Financial Case Management Representative will manage follow-up on rejected and denied claims while collaborating with clinical staff and payers in a remote setting.

Key responsibilities

• Follow up on rejected and denied claims using evidence-based support and documentation
• Work with Medical Information Management to ensure proper coding (ICD10 and CPT4) on claims
• Identify trends in denials and provide education to clinical staff and managed care payers to reduce these denials

Required qualifications

• Bachelor's degree or equivalent experience
• 2 years of relevant experience required; 2-4 years preferred
• Strong understanding of disease implications and treatment modalities
• Proficiency in Integrated Health Information Systems (IHIS)
• Ability to educate clinical and non-clinical staff on authorization requirements