Medical Records Specialist

Role Summary

Responds to medical record requests from insurance carriers at varying stages of claim processing as an integral part of recognizing the maximum reimbursement from each claim.

This position will be responsible for navigating the electronic medical record (EMR) and revenue platform to obtain/produce and transmit the records required by the applicable insurance carrier or third party.

Demonstrates understanding of explanations of benefits (EOBs) and ability to digest and respond appropriately to denials and medical insurance correspondence.

Aptitude in comprehending revenue-based and claim lifecycle account notes as well as clear and concise notation/documentation is paramount to success in the role.

Responsibilities

• Understand and comply with all governmental, regulatory, company billing/AR and compliance regulations/policies assigned by payers.
• Analyze EOBs and correspondence to construct medical record packages that accurately respond to request/claim adjudication.
• Identify and communicate specific payer information, issues, and/or trends to appropriate parties/departments.
• Follow up and complete tasks on pending accounts in a timely manner.
• Address denials and zero payments to identify and provide any requested documentation required to process the claim or refer to billing for claim corrections.
• Use of office equipment and software applications to facilitate finalization of claim.

Qualifications/Education/Experience

• High school diploma or GED equivalent required.
• 1-2 years of medical collections/medical office experience.
• Intermediate level of expertise using Microsoft Office Suite (Outlook, Excel, Word, Teams) and PDF software (NitroPro).
• Familiarity with insurance payer rules and regulations.
• Ability to affectively multi-task.
• Strong comprehensive and analytical skills.
• Effective verbal and written communication skills including professional phone skills.
• Detail-oriented.
• Able to function as a cooperative team member with a positive attitude.
• Must have ability to work independently with minimal supervision and maintain confidentiality.