Remote Revenue Cycle Medical Records Case Manager

Summary

Join our team as a Revenue Cycle Medical Records Case Manager and support documentation of medical necessity by facilitating medical records collection and client outreach, offering expert review and interpretation on a case-by-case basis, and maintaining collaborative relationships within the organization.

Requirements

• At least 3 years of relevant experience, including but not limited to: health care administration, case management, nursing, oncology/transplant clinic, medical billing/coding, appeals and denials management and/or insurance collections
• Bachelor's Degree (BS, LPN, RN, BSN, BSHA)
• Healthcare related field of study or equivalent experience (Clinical Case Managers)
• Knowledge of medical billing systems, medical terminology and abbreviations, basic procedure coding knowledge and health care nomenclature and systems
• Proficiency with G-Suite products, including Google Calendar and G-Sheets, and strong analytic skills with ability to interpret, evaluate and act on clinical information

Responsibilities

• Successfully obtain necessary medical documentation by collaborating with and serving as a primary liaison between in-house billing operations, customer experience groups and clinic medical records departments
• Have a thorough understanding and knowledge of applicable CMS, state, and insurer medical policy and coverage guidelines (in particular LCD & NCD Coverage Criteria)
• Ability to navigate and extract data from multiple versions of electronic medical records, including EPIC
• Serve as a source of knowledge for medical records (MR) review and interpretation, including in-depth review of provider progress notes and charts with the ability to identify critical data points highlighting why patient criteria meets medical necessity and summarizing in a succinct manner for health insurance companies
• An in-depth knowledge and understanding of oncology and organ health terminology (including chemotherapy treatments and well as immunotherapy treatments)
• Develop and cultivate ongoing working relationships with other departments impacting revenue cycle performance
• Participate in weekly meetings, daily discussions, case reviews and continuing education to review key metrics, workflows, trends, and performance improvement opportunities
• Prioritize performance initiatives and ensure productivity goals are achieved within a timely manner while maintaining the highest quality of work standards for Q/A

Benefits

• Competitive Benefits - Employee benefits include comprehensive medical, dental, vision, life and disability plans for eligible employees and their dependents
• Free testing in addition to fertility care benefits
• Pregnancy and baby bonding leave
• 401k benefits
• Commuter benefits