Medical Records Case Manager

Job Summary

To support revenue cycle management, the full-time Revenue Cycle Medical Records Case Manager will facilitate medical records collection, collaborate with internal teams, and provide expert review and interpretation of medical necessity documentation while working remotely.

Key responsibilities:

• Obtain necessary medical documentation by serving as a liaison between billing operations and medical records departments
• Review and interpret medical records to identify critical data points that demonstrate medical necessity for health insurance companies
• Participate in meetings and case reviews to analyze performance metrics and improve workflows related to revenue cycle performance

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)
• In-depth knowledge of CMS, state, and insurer medical policy and coverage guidelines
• Experience navigating electronic medical records systems, particularly EPIC
• Strong familiarity with oncology and organ health terminology