Clinical Finance Case Management - RN Specialist 2 - Revenue Cycle Clinical Support

Ohio State University

Job Overview

Location

Remote Location

Job Type

Full-time

Full Job Description

📋 Description

• The Clinical Finance Case Management - RN Specialist 2 - Revenue Cycle Clinical Support role is critical to ensuring accurate revenue cycle operations by preventing and appealing clinical denials through expert clinical and financial analysis.
• Day-to-day responsibilities include securing complex pre-authorizations, interpreting medical necessity guidelines, determining appropriate levels of care (inpatient or observation), serving as a Subject Matter Expert for payer-specific rules, managing clinical appeals and denials, and collaborating with legal, medical information management, physician groups, and business office teams.
• The role operates within The Ohio State University Wexner Medical Center’s Health System Shared Services | Revenue Cycle Clinical Support team, which supports cash collection by ensuring compliance with governmental, commercial, and internal audit requirements while aligning with JCAHO, CMS, and payer utilization management standards.
• The incumbent will develop deep expertise in revenue cycle finance, clinical documentation improvement, coding systems (ICD-10, CPT, HCPCS), managed care contracts, and denial management strategies, positioning them as a trusted advisor across clinical and financial departments.

🎯 Requirements

• Bachelor’s degree in nursing with current active RN license required.
• Minimum of 2 years of direct clinical care experience with patient care, anticipating needs, and understanding physician plans of care.
• Proven ability to collaborate effectively with physicians and their designees in clinical decision-making processes.
• Strong analytical skills with the ability to synthesize large volumes of clinical and financial data to make educated, evidence-based decisions.
• Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Teams, SharePoint, OneNote) and Adobe Professional, along with comfort navigating multiple healthcare applications including IHIS, payer portals, and 3M systems.
• Ability to communicate professionally and positively via email, phone, chat, and other mediums in a remote work environment.

🏖️ Benefits

• Fully remote work arrangement, allowing flexibility and work-life balance while contributing to a leading academic medical center.
• Opportunity to gain specialized expertise at the intersection of clinical nursing and healthcare finance/revenue cycle management.
• Exposure to complex payer systems, governmental audits (RAC, MAC, QIO), and denial management processes, enhancing career versatility.
• Access to Ohio State University’s comprehensive employee benefits package, including health insurance, retirement plans, and professional development resources.
• Regular first-shift schedule (40 hours/week) with predictable hours and no on-call or weekend requirements.
• Role based within a mission-driven organization committed to equity, inclusion, and veteran/disability employment opportunities.

Skills & Technologies

Remote

Degree Required

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Ohio State University

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About Ohio State University

The Ohio State University, founded in 1870, is one of America's largest public land-grant research universities, enrolling more than 66,000 students across Columbus and five regional campuses. A member of the Association of American Universities, Ohio State offers over 400 undergraduate, graduate and professional programs through 16 colleges, and is internationally recognized for pioneering research, innovation and community engagement. Buckeyes compete in NCAA Division I as part of the Big Ten Conference.

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