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Clinical Financial Case Manager- The James
Position Summary 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 c


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