Medical Records Specialist Job at Vital Care Infusion Services
Job Summary:
The role of the Medical Records Specialist is to review and respond to insurance correspondences and provide medical documentation to support accurate reflection of a patient’s clinical status. Perform functions to safeguard and protect the patient's right to privacy by ensuring that only authorized individuals have access to the patient's medical information, and all releases of information are in compliance with the request, authorization, company policy, and HIPAA regulations.
Duties/Responsibilities:
- Timely produce and deliver medical records in response to third-party payer requests and communicate with franchise partners and outline needs of any missing documentation to satisfy requests.
- Responsible for processing all release of information requests in a timely and efficient manner ensuring accuracy and providing customers with the highest quality product and customer service.
- Validate requests and authorizations for the release of medical information according to established procedures.
- Apply knowledge of medical terminology and clinical expertise to evaluate clinical documents
- Serve as a resource and communicate with franchises and other team members to facilitate or obtain comprehensive medical record documentation to reflect treatment
- Perform quality checks on all work to ensure the accuracy of the release, and confidentiality.
- Researches analyzes, recommends, and facilitates a plan of action to correct discrepancies and prevent future documentation discrepancies
- Provide excellent customer service by being attentive and respectful; ensure understanding of customer requests and follow-through as promised; being proactive in identifying client concerns or problems.
- May receive incoming requests including opening mail, telephone inquiries, and retrieving facsimile inquiries, depending on the needs of the business.
- Maintain working knowledge of the existing state laws.
- Works independently to meet or exceed productivity and accuracy goals
- Carry out responsibilities of all Vital Care policies and procedures, including HIPAA, and state/federal regulations.
- Maintain confidentiality, security, and standards of ethics with all information.
- Document actions taken within the systems in accordance with Vital Care processes.
- Perform other related duties as assigned.
Required Skills/Abilities:
- Excellent communications skills: listening, speaking, understanding, and writing English to advance reimbursement and collection efforts.
- Strong organization skills with the ability to track and maintain clear, complete records of activities, cases, and related documentation.
- Proven knowledge and skill in utilizing the MS Office suite of software and pharmacy applications.
- Advanced data entry skills.
Preferred Skills/Abilities:
- Understanding of anatomy and physiology disease process, medical terminology, and pharmacology.
- Proficiency in reading and interpreting documents such as medical records, clinical documentation, and insurance correspondence.
- Demonstrates ability to research clinical criteria and evaluate them for accuracy, and quality, and to ensure it meets accepted standards.
- Demonstrate ability to appropriately apply clinical criteria to a variety of claims and effectively utilize audit tools.
- Knowledge of ICD-10 and CPT/HCPC coding guidelines and terminology.
Education and Experience:
- High School Diploma or equivalent and additional specialized training (Required).
- Healthcare experience: +2 years (Preferred).
- Licensed practical nurse (Preferred)
- Clinical experience and knowledge of complex diseases (Preferred).
- Experience in reviewing and interpreting medical records (Preferred).
Vital Care Infusion Services is an Equal Opportunity Employer
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