Job Summary:

Ensure accurate and timely processing of medical records and authorizations, complying with regulatory requirements.

Key Responsibilities:

Authorizations (80%):

• Resolve all assigned authorizations promptly.
• Contact payors for status updates on pending requests.
• Submit and follow up on at least 10 authorizations daily.
• Verify patient insurance eligibility and benefits.
• Communicate procedure and diagnostic codes to obtain correct referrals and authorizations.
• Coordinate with internal personnel for detailed information.
• Update parties on insurance or procedural changes.
• Obtain same-day referrals and authorizations for visits and procedures.
• Identify primary and additional payers.
• Work with billing to reconcile authorization discrepancies.
• Support departmental and corporate strategic plans.
• Enter clinical and non-clinical data into databases accurately.
• Respond to calls and emails within 24 hours.
• Maintain client confidentiality.

Medical Records (20%):

• Collect, organize, and maintain medical records.
• Verify accuracy and completeness of records.
• Enter patient information into EHR systems.
• Process medical record requests per HIPAA regulations.
• Release information to authorized individuals/entities.
• Perform quality checks and correct discrepancies.
• Assist with accessing and retrieving medical records.
• Maintain and update filing systems.
• Collaborate to facilitate information flow.
• Ensure compliance with regulations and guidelines.

Education and Experience:

• High school diploma or equivalent; associate/bachelors in healthcare administration or related field preferred.
• Minimum 3 years of clinical or related experience.
• Preferred: Case management, utilization review, or prior authorization experience.
• Knowledge of third-party payer and NC-Medicaid rules preferred.
• Experience as a Medical Records Specialist or similar role in healthcare.
• Familiarity with medical terminology, anatomy, and physiology.
• Proficiency with EHR systems and medical record software (e.g., Epic, Cerner, Meditech).
• Understanding of HIPAA regulations and privacy laws.
• Strong attention to detail and accuracy.
• Excellent organizational and time management skills.
• Effective verbal and written communication skills.