Medical Records And Billing

1 month ago


Greenville, United States Wilkinson Staffing Agency Full time
Job DescriptionJob Description

The Billing/Authorizations and Medical Records Specialistwill be responsible for ensuring the accurate and timely processing of medical records and authorizations in compliance with regulatory requirements.


Essential Duties and Responsibilities include the following. Other duties may be assigned.

Key Responsibilities:

1.Authorizations (80%):

Ensure that all assigned Authorizations are resolved within appropriate time restraints

Research, follow-up, and resolve all open/pending Authorizations in a timely manner

Contact Payors for status of outstanding/pending Authorization request

Minimum requirements of 10 authorization submissions and or follow ups daily

Verifies patient insurance eligibility and benefits by means of Internet resources or manually procuring information from the insurance carrier

Conveys information regarding procedure codes and diagnostic codes in order to receive correct referrals for office visits and authorization for inpatient and outpatient hospital procedures

Communicates and coordinates with interdepartmental and interoffice personnel to procure correct and detailed information regarding all referrals and authorizations

Updates and informs all parties involved of any insurance or procedural changes regarding authorizations

Obtains all referrals and authorizations for office visits and outpatient procedures same day

Identify primary and, as applicable, additional payers, based on established payer coverage guidelines and criteria

Work with billing department to help reconcile discrepancies with authorizations and reimbursements

Actively support departmental and corporate strategic plans and ensured successful implementation

Met deadline requirements for authorization submissions

Accurately enter required information (clinical and non-clinical data) into various computer databases

Answer calls and emails from utilization management, hospitals, and staff using exemplary customer services skills, within 24 hours

Maintain client confidentiality, requiring consent for disclosure forms when sharing information

2.Medical Records (20%):

Collect, organize, and maintain medical records according to established procedures and guidelines.

Ensure the accuracy and completeness of medical records by verifying patient demographic and insurance information, medical history, diagnoses, treatments, and procedures.

Enter patient information into electronic health records (EHR) systems and ensure data integrity.

Process requests for medical records from healthcare providers, insurance companies, patients, and other authorized parties in accordance with HIPAA regulations.

Release medical information to authorized individuals and entities, ensuring compliance with privacy and confidentiality policies.

Perform quality checks on medical records to identify discrepancies or missing information and take corrective action as needed.

Assist healthcare providers and administrative staff with accessing and retrieving medical records as requested.

Maintain and update filing systems, both physical and electronic, to ensure efficient record storage and retrieval.

Collaborate with healthcare professionals and administrative staff to facilitate the flow of information related to medical records.

Stay informed about changes in regulations and guidelines related to medical records management and ensure compliance with all applicable laws and standards.

Education and/or Experience

  1. High school diploma or equivalent; associate or bachelors degree in healthcare administration, medical records, or related field preferred.
  2. Minimum of 3 years clinical and/or related experience.
  3. Must be able to work in a fast pace environment in which information is constantly changing.
  4. Case Management, Utilization Review or Prior Authorization experience is preferred.
  5. Knowledge of third party payer and NC-Medicaid rules and regulations preferred.
  6. Well organized and able to multi-task quickly and effectively.
  7. Knowledge of basic computer skills such as Microsoft Office Suite (Outlook, Word, Excel, Sharenote, etc.).
  8. Ability to effectively present information and respond to questions from management, clients, auditors and internal customers.
  9. Proven experience working as a Medical Records Specialist or in a similar role within a healthcare setting.
  10. Knowledge of medical terminology, anatomy, and physiology.
  11. Familiarity with electronic health records (EHR) systems and medical record software (e.g., Epic, Cerner, Meditech).
  12. Understanding of HIPAA regulations and other privacy laws governing the release of medical information.
  13. Strong attention to detail and accuracy in data entry and record keeping.
  14. Excellent organizational and time management skills.
  15. Ability to maintain confidentiality of patient information and exercise discretion in handling sensitive data.
  16. Effective communication skills, both verbal and written, with the ability to interact professionally with healthcare professionals, patients, and external parties.
  17. Proficiency in using computers and software applications, including MS Office (Word, Excel, Outlook) and database management.

Position Type: Full-time

Location: Corporate Office is in Greenville, minimum travel to sites if needed.





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