Medical Records Specialist

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Receive, review, and process medical record requests from: Third-party vendors, Insurance carriers, Healthcare providers, Internal departments, Government agencies, Recovery Audit Contractors (RAC), Commercial and Medicare auditors.
• Validate request authenticity and authorization requirements prior to releasing records.
• Retrive medical records from electronic health record (EHR), document management, and imaging systems.
• Compile, review, and submit complete and accurate medical documentation in response to: Medical record requests, Audit requests, Additional Documentation Requests (ADR), Pre-payment and post-payment audits, Claims appeals and denials.
• Maintain detailed logs and tracking reports of incoming and completed requests.
• Collaborate with providers, coding teams, billing departments, compliance teams, and payers to obtain missing documentation.
• Ensure compliance with HIPAA, CMS guidelines, state regulations, organizational policies, and release-of-information requirements.
• Research and resolve issues related to incomplete, duplicate, or denied record requests.
• Respond to provider inquiries regarding submitted requests and audit documentation.
• Maintain confidentiality and security of protected health information (PHI).
• Assist with process improvement initiatives to enhance productivity, compliance, and customer service.

QUALIFICATIONS

• Ability to handle high call volumes and multitask effectively.
• Proficiency in computer systems and electronic health records (EHR).
• Detail-oriented with strong organizational skills.
• Strong knowledge of medical billing and coding practices.
• Familiarity of ICD-10, CPT, HCPCS.
• Strong Insurance Knowledge.
• Must demonstrate strong analytical skills and proficiency with Microsoft office products.
• Must have strong critical thinking skills.
• Maintains effectiveness when experiencing major changes in work tasks or the work environment.
• Ability to work independently without close supervision.
• Ability to exercise judgement and make decisions.
• Ability to perform in a high productivity, fast-paced environment.
• Interpersonal skills and conflict resolution.
• Attention to detail.
• Excellent phone and computer skills.
• Ability to maintain sensitive information in confidence.
• To meet deadlines and prioritize responsibilities.
• Ability to train staff and write protocols and training materials.
• Strong ability to uphold organizational values, work with integrity and ethically, inspire the trust of others, and treat people with respect.
• Strong HIPAA and OSHA knowledge.