California Licensed Medical Records Case Manager

Job Summary

Supporting documentation of medical necessity, the temporary California Licensed Medical Records Case Manager will work remotely to facilitate medical records collection, provide expert review and interpretation, and maintain collaborative relationships within Revenue Cycle Management.

Key responsibilities

• Obtain necessary medical documentation by collaborating with in-house billing operations and clinic medical records departments
• Review and interpret medical records, identifying critical data points to support medical necessity for health insurance companies
• Participate in case reviews and discussions to improve revenue cycle performance and ensure compliance with regulations

Required qualifications

• At least 3 years of relevant experience in healthcare administration, case management, or medical billing/coding
• Bachelor's Degree in a healthcare-related field (BS, LPN, RN, BSN, BSHA)
• Thorough understanding of CMS, state, and insurer medical policy and coverage guidelines
• Experience in an Oncology or Transplant clinical setting is strongly preferred
• Proficiency with G-Suite products and strong analytical skills for interpreting clinical information