Revenue Cycle Medical Records Case Manager-Temp

Revenue Cycle Medical Records Case Manager

Job Description Summary

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

OUR OPPORTUNITY

WHAT WE OFFER