Revenue Cycle Medical Records Case Manager

Summary

Join Natera as a Revenue Cycle Medical Records Case Manager and support medical necessity documentation by facilitating medical record collection, client outreach, and expert review. You will collaborate with internal teams and external clients, ensuring compliance with medical policies and guidelines. This role requires strong analytical skills, knowledge of medical terminology, and experience in healthcare administration or a related field. You will prioritize performance initiatives, maintain high-quality work standards, and adhere to compliance standards. Natera offers competitive benefits, including comprehensive medical, dental, vision, life, and disability plans, as well as free testing for employees and their families. The role is remote and offers a competitive salary.

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
• Excellent organizational, time management and problem solving skills
• Excellent interpersonal skills as well as the ability to work with a variety of internal and external colleagues from all levels of an organization
• Ability to work in a high performing, fast paced team environment that requires flexibility
• Ability to navigate across multiple customer demands and balance competing priorities successfully
• Ability to analyze, identify and articulate/report trends succinctly in a clear and concise manner
• Ability to solve problems using critical thinking skills
• Maintains confidentiality of sensitive PHI 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
• Follow department procedures and ensure all activities are documented and conducted within compliance standards with applicable business process requirements and regulatory requirements
• This role requires access to Patient Health Information (PHI) both in paper and electronic form. Therefore, employees must complete training relating to HIPAA & PHI privacy, General Policies and Procedure Compliance training and security training as a requirement of the job

Preferred Qualifications

Previous experience working in an Oncology or Transplant clinical setting strongly preferred

Benefits

• Employee benefits include comprehensive medical, dental, vision, life and disability plans for eligible employees and their dependents
• Additionally, Natera employees and their immediate families receive free testing in addition to fertility care benefits
• Other benefits include pregnancy and baby bonding leave, 401k benefits, commuter benefits and much more
• We also offer a generous employee referral program!
• Remote USA