Medical Records Specialist

The medical records specialist is responsible for organizing and maintaining all aspects of client medical records for accuracy and compliance with local, state, federal, and LME/MCO rules and regulations.

Job responsibilities:

• Maintain client charts and ensure that medication administration records (MARs) and other medication-related issues are corrected and submitted prior to deadline.
• Open new client charts for both physical and electronic healthcare records (EHRs).
• Gather client quarterly monitoring documentation for timely submission to care managers upon request.
• Consult with the Agency’s pharmacy regarding clients’ medications and all pharmacy-related issues.
• Complete weekly billing for all services rendered for applicable local management entities (LMEs) and managed care organizations (MCOs).
• Review and track weekly RA reports for claims denials and other billing discrepancies.
• Contact claims specialists for billing discrepancies and claims denials to ensure timely solutions and recoupment of funds.
• Provide or arrange technical assistance to support staff, as needed.
• Assist qualified professionals (QPs) with the intake process (e.g., consent packets, pharmacy/MAR profile, etc.) for new clients and as needed updates.
• Ensure client records are audited monthly at the corporate office.
• Review monthly clinical documentation for accuracy and completion (e.g., MARs, ISP data, sleep logs, client inventory sheets, funds logs, body checks, medical consultation forms, etc.) for accuracy and file bi-weekly.
• Purge client charts according to the state’s Records and Retention Manual and maintain active and non-active list of clients (client admission and discharge spreadsheet).
• Review the Records Retention Manual monthly to gain a better understanding of this job requirement.
• Safeguard and comply with all HIPAA and confidential practices for the protection of protected health information (PHI).
• Participate in all required team meetings, committees, and audits as required.
• Express ideas clearly and be able to plan and execute work effectively.
• Establish and maintain effective working relationships with colleagues, employees, clients, guardians, and other stakeholders.
• Execute additional responsibilities as assigned by the supervisor.

Communication:

• Maintain consistent communication with his/her supervisor regarding clinical documentation, service authorizations, and medication/pharmacy-related concerns.

Qualifications:

Must have a high school diploma or GED. An associate degree and experience working in mental health care is preferred, but not required.

Required skills:

• Must successfully complete all Agency required training and in-services for this position.
• Basic mathematical skills.
• Ability to read, write, and formulate coherent, concise thoughts.
• Ability to follow instructions and receive constructive criticism.
• Ability to work independently or as a team member.
• Valid driver’s license, reliable transportation, acceptable driving record, and clean criminal background and health care personnel registry checks.

Performance expectations:

• The medical records specialist will serve as a role model to support staff, by consistently conducting him/herself in a professional and ethical manner in all situations, including but not limited to promptness of completing assignments, verbal/non-verbal communications, maintaining professional boundaries, representing Agency with a professional image, appropriate attire (see employee handbook), complying with federal anti-kickback laws, and not engaging in, or coercing others to engage in, any fraudulent behavior (see Federal Anti-Kickback Laws and Medicaid Fraud Defined)
• Have or develop a working knowledge of various forms of developmental disabilities and common accompanying issues.
• Monitor the Division of MH/DD/SAS, Division of Medical Assistance, Beacon Health Options, and LME/MCO websites for changes that impact services provided.
• Have or develop a working knowledge of rules, service definitions, and statutes governing the provision of the services provided.
• Have or develop a working knowledge of all applicable authorization/re-authorization processes, Agency policies and procedures, documentation requirements, and billable tasks.
• Have or develop a working knowledge of local community resources, both public and private.
• Maintain a person-centered focus throughout service provision.
• Serve as a team player to the general office staff and Agency as a whole.
• Provide services according to the philosophy, standards, values, and ethics set forth by the Agency.
• Follow all Agency policies and procedures.
• Maintain current training and certifications/licensure requirements.

Accuracy required in work and consequence of error:

This position has a fiduciary responsibility to the Agency, including but not limited to, billing, in which errors could result in significant funding infractions for the Agency.