What are the responsibilities and job description for the Medical Records Tech. position at Cedar Riverside People'?
JOB TITLE: Medical record Technician
SUPERVISOR: Director of Patient Experience and Relations
Summary:
A Medical Record Technician (MRT) plays a crucial role in the healthcare system by managing patient health records with accuracy, security, and confidentiality. MRT ensure that medical documents are well-organized, up to date, and compliant with regulations such as HIPAA (Health Insurance Portability and Accountability Act). MRTs work closely with physicians, nurses, and administrative staff to maintain seamless record-keeping, ensuring efficient patient care and proper billing.
Key Responsibilities:
1. Record Management & Organization:
- Review, organize, and maintain patient medical records.
- Ensure accuracy and completeness of medical documents.
- Assign and classify medical codes for diagnoses and procedures (ICD-10, CPT).
- Process requests for medical records while maintaining confidentiality.
- Work with healthcare providers to update patient records.
- Ensure compliance with HIPAA and other healthcare regulations.
- Use electronic health record (EHR) systems to manage data.
- Prepare reports and retrieve data as needed.
2. Data Entry
- Verify and cross-check patient data for completeness and correctness.
3. Compliance & Confidentiality:
- Ensure all records comply with HIPAA and other healthcare privacy laws.
- Protect sensitive patient information and prevent unauthorized access.
- Maintain compliance with state and federal regulations regarding medical documentation.
4. Electronic Health Record (EHR) Management:
- Use EHR software to input and retrieve patient records.
- Troubleshoot and resolve basic EHR-related issues.
- Work with IT teams to improve digital record management systems.
5. Communication & Coordination:
- Coordinate with physicians, nurses, and insurance companies to clarify medical documentation.
- Respond to patient or legal requests for access to medical records.
- Assist in audits and inspections by providing requested medical records.
Required Skills & Competencies:
Technical Skills:
- Proficiency in Electronic Health Records (EHR) systems such as Epic.
- Strong data entry and record-keeping skills.
Soft Skills:
- Excellent attention to detail to ensure accurate record-keeping.
- Strong organizational and time-management abilities.
- Problem-solving skills to resolve record discrepancies.
- Effective verbal and written communication.
Compliance Knowledge:
- Understanding of HIPAA regulations and healthcare privacy laws.
- Familiar with Medicare, Medicaid, and private insurance policies.
Qualifications & Education:
- Minimum: High school diploma or GED.
- Preferred: Associate degree or certification in Health Information Management (HIM), Medical Coding, or a related field.
Certifications (Preferred but Not Required):
- Registered Health Information Technician (RHIT) – from AHIMA.
- Certified Coding Specialist (CCS) – from AHIMA.
- Certified Electronic Health Records Specialist (CEHRS) – from NHA.
- Certified Professional Coder (CPC) – from AAPC.
Work Environment & Conditions:
Typical Workplaces:
- Hospitals
- Clinics
- Private medical practices
- Nursing homes
- Insurance companies
- Government healthcare agencies
Work Conditions:
- Office setting with extended computer use.
- May require sitting for long hours and handling large amounts of data.
