Medical Record Clerk

About the role

The Centers for Medicare & Medicaid Services (CMS) Comprehensive Error Rate Testing (CERT) program supports the CMS's obligations under the Payment Integrity Information Act (PIIA). This program uses statistically valid sampling and independent medical review of claims to identify improper payments and measure program performance. The insights generated through CERT enable CMS to strengthen accountability, improve healthcare delivery practices, and drive corrective actions that protect both beneficiaries and public funds.

Responsibilities

• Process initial medical record requests including printing pull lists, requesting letters and coversheets, photocopying of materials, scanning mailing labels, packing initial request envelopes with all required documents, and mailing via postage meter and U. S. Postal Service
• Adjudicate ADR (Additional Documentation Request) for TS (Technical Validation / Technical Services context) / MRS (Medical Review Specialist) call requests from the MRS and First Touch reviewers
• Download and sends out medical records to MACs (Medicare Administrative Contractors) and CMS upon request
• Set up new users and resets passwords for MAC users to access the CERT Website
• Process the medical records and appeals requested by MACs
• Attend required education and training programs
• Comply with departmental policies and procedures
• Perform other duties as assigned by the Medical Records Manager

Qualifications

• A high school diploma/GED
• Knowledge of medical record processing
• Ability to lift and move boxes repetitively weighing up to 50 pounds
• Ability to work independently and as a team member to achieve Service Level Agreements
• Ability to QC a high volume of claims on a daily basis
• Ability to work under pressure and within designated time constraints
• Ability to solve problems and resolve issues as they arise
• Ability to multitask
• Knowledge of personal computer systems including MS Word, MS Excel
• Familiarity with department required equipment (computers, copiers, fax machines, scanners)
• Ability to perform record imaging after training
• Ability to file and retrieve records
• Pay close attention to detail
• Knowledge of medical terminology

Additional Desired Qualifications

• 6 months of medical record experience

Benefits

Eligible employees also gain access to a wide range of benefits from comprehensive health coverage and health savings accounts to retirement plans, life and disability insurance, and time-off programs that support work-life balance. Program availability may vary based on factors such as contract type, location, hire date, and applicable collective bargaining agreements.