Medical Records Specialist

Key Responsibilities :

• Review the case and the medical records on file to identify any missing information.
• When unavailable, obtain medical records contacts, phone numbers, and fax numbers for physician's office.
• Submit requests for medical records to the MD office and follow up on those requests per client guidelines.
• Request test results from client if not on file.
• Submit medical records to the insurance company or provide records to be filed with an appeal.
• Comply with all Medical Records Needed - CLM and Medical Records Needed - Appeal worklist process, system, and documentation SOPs (Standard Operating Procedure).
• Meet worklist and follow-up time requirements to complete assigned worklist tasks promptly.
• Send an appropriate letter to the payer when all available records have been sent, and the claim / appeal is still pending.
• Participate in team meetings by sharing the details of cases worked.
• Ability to meet predetermined Productivity Goals based on the level of Appeal.
• Ability to meet Quality Standard in place (90% or greater)
• Other duties as assigned.

Education / Experience :

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.