Job Description Summary

The Revenue Cycle Medical Records Case Manager will support documentation of medical necessity by facilitating medical records (MR) collection and client outreach, by offering expert review and interpretation on a case by case basis, and by maintaining collaborative and productive relationships within the organization relating to Revenue Cycle Management.

Job 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

Qualifications:

• 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)

Required Knowledge, Skills and Abilities:

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