Medical Records Clerk

Job Description

Job Description

Description :

Job Title : Medical Records / Prior Authorizations Clerk

Reports To : Medical Records Supervisor

FLSA Status : Non-Exempt

Starting @ $19.15 per hr.

Summary : The Medical Records Clerk works in the Administration office updating the patient’s health records and history. Receiving incoming faxes, mail, distribution and coordinating home health documents. You will ensure that our clinical documentation is accurate and complete. As part of this role, you will ensure compliance with state and federal regulations, including HIPAA guidelines.

Essential Duties and Responsibilities

• Perform clerical and administrative duties utilizing specific knowledge of medical terminology HIPAA, and hospital, clinic, or laboratory procedures. Duties include compiling and recording medical charts, reports, and correspondence.
• Update patients' electronic health records (EHR)
• Validate requests and authorizations for the release of medical information.
• Ensure that clinical documentation of the services provided to our patients is correct.
• Follow all HIPAA regulations.
• Operate office equipment such as voicemail messaging systems, and use word processing, spreadsheet, and other software applications to prepare reports,
• Compile and record medical charts, reports, and correspondence using a computer and various software programs.
• Transmit correspondence and medical records by mail, e-mail, or fax.
• Attach or create electronic orders for incoming results.
• Keeps health care providers informed by communicating the availability of requested records.
• Maintain medical records, technical library, and correspondence files.
• Obtains quality results by following guidelines and standards.
• Perform various clerical and administrative functions, such as ordering and maintaining an inventory of supplies.

Collaborate with insurers to obtain pre-authorizations for condition-specific medications.

Submit prior authorization requests for medications as required by insurance providers.

Communicate with insurance representatives to clarify requirements, resolve authorization denials, and follow up on pending approvals.

Collaborate with physicians, nurses, and pharmacies to obtain additional clinical information or documentation required by insurance companies.

Maintain accurate and detailed records of all prior authorization requests, outcomes, and patient information in compliance with HIPAA regulations.

Meet quality and productivity standards set by Family Healthcare.

Stay updated on changes in insurance policies, state and federal regulations, and organizational policies affecting prior authorizations and reimbursement.

Requirements :

Qualifications - Education / Experience :

1. High school diploma or GED equivalent

2. Medical Records / Prior Authorization experience minimum 2 years

3. Bilingual in English and Spanish preferred

4. Basic familiarity with medical routine and terminology. General knowledge of CPT / HCPCS and ICD-10

5. Ability to function effectively in a fast-paced environment.

6. Strong written and verbal communication skills with the ability to explain complex medical and insurance information

7. Ability to work well as a team, exhibit integrity, use good judgment and keep confidential information.

8. Demonstrate reliable attendance and punctuality.

9. Electronic health record experience preferred.

10. Personal traits of a high-level commitment, motivation, energy, team orientation, professionalism, trust, personal honesty and integrity, and a demonstration of placing others in a place of high value.

Salary : $19