Medical Records Specialist Job Description

Medical Records Specialist Job Description

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Medical records specialist provides in-depth technical expertise for Safety and Health policies, Occupational Safety and Health Administration regulations, and other job-specific procedures or standards.

Medical Records Specialist Duties & Responsibilities

To write an effective medical records specialist job description, begin by listing detailed duties, responsibilities and expectations. We have included medical records specialist job description templates that you can modify and use.

Sample responsibilities for this position include:

Communicates with manager on an on-going basis
Scanning Authorization Referrals
Scanning Incoming Reports from hospitals
Printing and Sending Requests for surgeries
Providing requested medical records appropriately and timely
Scanning documentation into patient files as needed
Prepare Patient charts for upcoming visits
Ensure that appropriate reports are filed in each patient chart and that applicable signatures are obtained in a timely manner
Ensure that the "missing dictation" report is completed on a daily basis
Follow-up with the surgeon's office or the dictation service regarding missing operative reports within 24 hours of the procedure

Medical Records Specialist Qualifications

Qualifications for a job description may include education, certification, and experience.

Licensing or Certifications for Medical Records Specialist

List any licenses or certifications required by the position: BLS, RHIT, CCS, CAHIIM, CPC, CTR, ART, RHIA, RRA, CPR

Education for Medical Records Specialist

Typically a job would require a certain level of education.

Employers hiring for the medical records specialist job most commonly would prefer for their future employee to have a relevant degree such as Associate and Collage Degree in Education, Medical, Health, Department of Education, Technical, Graduate, Business, Office Management, Medical Terminology, Health Information Management

Skills for Medical Records Specialist

Desired skills for medical records specialist include:

Medicare guidelines governing home health agencies
Policies & procedures and HIPAA regulations and to complete work in compliance of these and other standards
Release of Information standards
Current state laws regarding fee structure
HIPAA regulations facility policies and procedures in regards to release of information
Manager
Safety procedures to ensuring a safe work environment and reports safety concerns to Supervisor
Operations
Company and facility software
Medical Terminology

Desired experience for medical records specialist includes:

Send appropriate letters/facsimiles for delinquent reports to the surgeon's office in accordance with facility policy
Ensure medical records are filed in an accurate and timely fashion in accordance with facility policy
Ensure pathological and laboratory results are obtained and filed appropriately in a timely manner
Ensure appropriate signatures are obtained from staff members, anesthesiologists, and surgeons within a 60-day period
Ensure all incoming documents are filed appropriately in patient charts
Review all requests for copies of medical records to ensure authenticity, non-expired signatures, and HIPAA compliance

Medical Records Specialist Examples

1

Medical Records Specialist Job Description

Job Description Example
Our growing company is looking to fill the role of medical records specialist. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for medical records specialist
  • Retrieves and sorts medical records into proper chart order, ensuring that records are updated
  • Reviews and audits medical records for chart reviews
  • Processes requests for health information
  • Handles phone calls to explain compliancy policy and requirements of immunization policies
  • Reviews submitted immunization records
  • Assists in orientation sessions to collect immunizations and clear MMR holds
  • Work in an office setting and use office equipment
  • Candidate will be required to send documents to Anthem via a correspondence delivery system to be determined by the department
  • Responsible for performing Clinical Documentation Improvement (CDI) chart reviews (concurrent, pre-bill and retrospective) for improving overall quality and completeness of clinical documentation for inpatient accounts
  • Facilitate modifications to clinical documentation through extensive interaction with physicians, nursing staff, other patient caregivers, and health records coding staff to improve quality, accuracy, and completeness of clinical documentation in real-time
Qualifications for medical records specialist
  • Knowledge of HIPAA rules and regulations preferred
  • Analyze content of medical records to ensure compliance with TRICARE contractual requirements for timeliness and documentation
  • Request medical records, enter information into database, and send follow-up letter to facility if records not received
  • Prepare, scan, and perform review of scanned medical records to ensure that a quality reproduction has been made
  • Distribute the medical records appropriately through the Department according to government contract requirement or appropriate requestee including in the TriCare Quality Monitoring Committee (TQMC)
  • Complete payment voucher and send to finance for processing
2

Medical Records Specialist Job Description

Job Description Example
Our company is growing rapidly and is looking to fill the role of medical records specialist. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for medical records specialist
  • Monitors the accuracy and completeness of clinical information used for measuring and reporting physician and medical center outcome data
  • Communicates with members of the patient care team on clinical documentation improvement strategies and workflows, including a real-time physician escalation process and real-time concurrent notifications (utilization review, quality and risk management)
  • The candidate in this position will be instrumental with enhancing the overall quality completeness and accuracy of hospital health record documentation
  • Track all communications
  • Process requests for private health information (PHI), narrative reports, depositions, telephone or in-person conferences from patients, attorneys, insurance companies, Creates, tracks and collects pre-payment billings for such reports/records
  • Organize patient files when necessary
  • Date stamps incoming documents to facilitate processing
  • Proper invoicing for medical records
  • Verify immunizations and enter the data
  • Attend student orientation/registrations to input immunization data
Qualifications for medical records specialist
  • Ability to work between during the hours of 6 am
  • Must have experience with EMR or EHR
  • Experience with providing visible participation and support of major change initiatives preferred
  • Receive and review incoming medical records - must understand the difference in a progress note and physician's note on a medical record
  • Follow-up on incomplete requests from facilities - should have exceptional phone and email etiquette
  • Experience working with EMR systems (Epic, Allscripts)
3

Medical Records Specialist Job Description

Job Description Example
Our growing company is searching for experienced candidates for the position of medical records specialist. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for medical records specialist
  • Provides excellent customer service by being attentive, respectful and professional at all times
  • Maintains a neat, clean, and professional appearance and observes the dress code established by the company
  • Maintains a clean and orderly work area, ensure that records are properly stored before leaving area
  • Works within scope of position and direction, willingly accepts assignments and is available to take on additional duties and assist where needed
  • Maintains confidentiality, information security and ethical behavior when handling all medical records
  • Attends and participates in required education training sessions and staff meeting as scheduled and assigned
  • Promptly reports any customer service concerns to supervisor and or any potential HIPAA violations whether actual or perceived
  • Informs supervisor of work difficulties, special project request from unit, and fluctuation volume in daily workload
  • Checks the company‚Äôs email and communication systems, such as public folder and EPM, to processes emails on a daily basis
  • May coordinate efforts for compliance to subpoena requests from the General Counsel regarding medical records
Qualifications for medical records specialist
  • Leads quality improvement activities, meetings and discussions with and between other departments within the Health Plan
  • Must have previous medical records experience
  • Must be dependable, organized, confidential and able to work in a fast-paced corporate environment
  • Must demonstrate proficiency with general office software (Microsoft Word, Excel and PowerPoint)
  • Must have a desire to work in the healthcare field
  • Preferred certifications include Registered Health Information Technician (RHIT) or Certified Coding Specialist (CCS)
4

Medical Records Specialist Job Description

Job Description Example
Our growing company is looking for a medical records specialist. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for medical records specialist
  • The Hospice Medical Records Specialist participates in the Hospice's QA/PI program, including auditing medical records, collecting data, and preparing reports as directed
  • He/she addresses all outside requests for medical records or related information
  • The Hospice Medical Records Specialist also assists with new employee orientation and continuing employee education
  • Documentation is compliant with Hospice regulations
  • Reporting discrepancies
  • Release of records compliance
  • Hospice requirements for documentation
  • Enters all prescription and order information in current software system
  • Documents procedures and processes for entry of orders in the software system
  • Sets up electronic patient medical record file and scans in all medical record documentation received with order
Qualifications for medical records specialist
  • Minimum of one (1) year ICD-9-CM coding and abstracting experience in a health care environment or medical records department
  • Knowledge of typewriter/word processor, personal computer and other routine office equipment
  • Ability to maintain a 95% coding accuracy rate and to process a minimum of 25 charts per day
  • Effective oral and written communication skills are required to work with medical, nursing, and other allied health staff external medical facilities requesting medical record information
  • Develops/assists with account management and ongoing training of various office users
  • Evaluate clients' workflows, documents and procedures for implementation and customized follow-up training
5

Medical Records Specialist Job Description

Job Description Example
Our growing company is searching for experienced candidates for the position of medical records specialist. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for medical records specialist
  • Manages all incoming faxes by copying to appropriate electronic patient medical record or forwarding to appropriate employee
  • Manages all medical record documentation received by mail or other sources and scans into appropriate electronic patient medical record
  • Communicates receipt of documentation and assigns task in current software system to appropriate employee for next step in process
  • Consistently organizes and maintains electronic patient medical records with established format and process
  • Enters new prescribers, Health Care team members and facility information into current software system using established protocol
  • Periodically reviews prescriber and facility information and inactivates any duplicated information in appropriate standard protocol
  • Performs EMR audits to ensure accuracy
  • Provides necessary follow-up throughout the process
  • Seeks and suggests improvements
  • Cross-Trains to help other customer care team members
Qualifications for medical records specialist
  • Assist with special "out-of-the-box" technologically innovative and clinically forward projects
  • Conduct off-site visits to client offices mainly located in Nassau, Suffolk and Queens
  • Some night and weekend remote support may be required
  • Associates degree minimum requirement
  • Must have minimum of 1 year of work experience in EMR/EHR implementation in a healthcare setting
  • Experience with Microsoft Word/Excel required

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