Medical Records Assistant

About the role

Western Slope Healthcare Center is seeking an organized, detail-oriented Medical Records Assistant to join our team! If you enjoy working behind the scenes to support exceptional resident care while ensuring accuracy, confidentiality, and regulatory compliance, we'd love to hear from you. In this role, you'll be responsible for maintaining resident medical records, supporting health information management processes, assisting with medical record compliance, and collaborating with our interdisciplinary team to ensure accurate and timely documentation. This is an excellent opportunity for someone who enjoys administrative work in a healthcare environment and wants to make a meaningful impact every day.

What You'll Do

Medical Records & Health Information

• Maintain resident medical records in accordance with federal, state, HIPAA, and facility regulations.
• Assemble, organize, audit, and file resident charts for completeness and accuracy.
• File nurses' notes, physician documentation, assessments, laboratory reports, diagnostic results, and other clinical documentation.
• Retrieve and distribute resident medical records to authorized personnel.
• Process admissions, discharges, and maintain required medical record registries.
• Monitor incomplete charts and follow up with departments for corrections.
• Assist with indexing, coding, and organizing medical records.
• Maintain documentation regarding authorized release of medical information.
• Process requests for medical records from physicians, insurance companies, Medicare, Medicaid, VA, and other authorized agencies.
• Ensure confidential records remain secure and are released only according to facility policy.

Administrative Support

• Assist with organizing and maintaining the Medical Records Department.
• Prepare meeting minutes and maintain departmental documentation.
• Answer telephone inquiries regarding medical records.
• Prepare reports and correspondence as requested.
• Support the MDS Coordinator by assisting with assessment scheduling.
• Enter and retrieve resident demographic information using the electronic health record system.
• Perform committee support and secretarial duties as assigned.

Compliance & Confidentiality

• Protect resident privacy and maintain strict HIPAA compliance.
• Safeguard confidential employee and resident information.
• Report suspected privacy violations or unauthorized system access immediately.
• Participate in facility surveys and regulatory inspections.
• Assist with audits to ensure documentation accuracy and regulatory compliance.

Teamwork

• Build positive working relationships with nursing, therapy, admissions, business office, and interdisciplinary staff.
• Participate in mandatory in-services and continuing education.
• Assist with additional administrative duties as assigned.

Qualifications

Required

• High School Diploma or GED.
• Ability to type a minimum of 45 words per minute.
• Strong computer skills with experience entering and retrieving electronic data.
• Excellent organizational skills and attention to detail.
• Strong communication and customer service skills.
• Ability to maintain confidentiality and work with sensitive information.

Preferred

• Previous experience in Medical Records, Health Information Management, or healthcare administration.
• Working knowledge of medical terminology, anatomy, physiology, medical coding, and health information management.
• Experience in a skilled nursing facility, rehabilitation center, or healthcare setting.
• Experience using electronic medical record systems.

We're Looking For Someone Who Is

• Highly organized and dependable.
• Detail-oriented and accurate.
• Professional, respectful, and compassionate.
• Able to prioritize multiple tasks in a fast-paced environment.
• A team player with excellent interpersonal skills.
• Committed to protecting resident privacy and maintaining compliance.

Physical Requirements

• Ability to move throughout the facility during the workday.
• Ability to occasionally lift, push, pull, or carry up to 25 pounds.
• Ability to use standard office equipment and computer systems.
• Ability to respond during emergency situations as needed.

Pay

$20.00–$23.00 per hour

Schedule

Full-Time, Monday - Friday 8:30 am - 5:00 pm

Benefits

• Comprehensive Medical, Dental, Vision, and Life Insurance
• Paid Time Off (PTO) and paid holidays
• Retirement savings plan
• Ongoing training and professional development
• Supportive leadership team
• Opportunities for career growth within our organization
• Rewarding work serving seniors in our community