Revenue Cycle Medical Records Case Manager

TEKsystems - Austin, TX

Full-time - Mid Level

Austin, TX

10,001+ employees

Professional, Scientific, and Technical Services

About the position

The Revenue Cycle Medical Records Case Manager at TEKsystems is responsible for supporting the documentation of medical necessity by facilitating the collection of medical records and client outreach. This role involves expert review and interpretation of medical records on a case-by-case basis while maintaining collaborative relationships within the organization related to Revenue Cycle Management.

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 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.

Requirements

• Experience in medical records management and revenue cycle processes.
• Knowledge of CMS, state, and insurer medical policy and coverage guidelines.
• Proficiency in navigating electronic medical records systems, particularly EPIC.
• Strong analytical skills for reviewing medical records and identifying critical data points.
• In-depth knowledge of oncology and organ health terminology.

Nice-to-haves

• Experience in a healthcare setting, particularly in oncology or organ health.
• Familiarity with HIPAA regulations and compliance training.