Greenville, NC, United States
Medical Records & Authorizations Manager
Job Description:
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.
Required Skills:
Medical Records Records
Salary Package:
$ 45,000.00 - 60,000.00 (US Dollar)
Package Details:
Full benefits after 90 days.