Position: Medical Record Review Specialist
Reports To: Medical Records Department Supervisor
Employment Status: Full-Time
FLSA Status: Non-Exempt
Job Summary:
The Medical Record Review Specialist is responsible for conducting thorough reviews of behavioral health medical records to ensure accuracy, compliance, and completeness. This role collaborates closely with other departments, including billing and clinical services, to uphold the highest standards of documentation for our clients.
Duties/Responsibilities:
- Conducts regular reviews of client medical records for accuracy, completeness, and compliance with industry standards and regulatory requirements.
- Identifies inconsistencies, discrepancies, or missing documentation within the records.
- Ensures that all documentation supports the billing claims made.
- Provides detailed feedback to providers and other relevant personnel regarding documentation quality, areas of improvement, and potential risks.
- Generates regular reports on review findings, including trends, areas of concern, and recommendations for training or process improvement.
- Works closely with billing teams to address any documentation concerns that could impact the billing process.
- Collaborates with the clinical services team to ensure clarity and understanding of documentation requirements.
- Stays updated with changes in behavioral health documentation standards, regulatory requirements, and best practices.
- Participates in internal training sessions and provides insights to develop training materials based on review findings.
- Maintains a systematic method of tracking reviewed records, findings, and feedback given.
- Uses electronic health record systems and billing software proficiently.
- Contributes to the continuous improvement of internal processes, ensuring that the company's quality assurance methods are both efficient and effective.
- All other duties as assigned.
Required Skills/Abilities:
- Strong attention to detail and accuracy.
- Proficiency in electronic health record systems and billing software.
- Strong communication and interpersonal skills.
- Ability to work independently and as part of a team.
- Problem-solving and critical thinking skills.
Benefits
- 401(k) plan with matching contributions