Medical Records Reviewer

Job Description

Bienvivir All-Inclusive Senior Health ("Bienvivir") is a community-based, patient-centered, comprehensive health care delivery system that advocates and promotes quality of life, optimum independence, dignity, and choices in a nurturing environment for frail seniors. Since 1987, Bienvivir has served the frail seniors of El Paso, Texas through the provision of the Program of All-Inclusive Care for the Elderly ("PACE").

PACE is a unique managed care benefit for frail seniors (referred to as participants) age 55 and older who are certified by the state as needing nursing home level care and who reside in a PACE service area. PACE programs coordinate and provide comprehensive medical and support services so that participants can remain independent and stay in their homes for as long as safely possible.

BENEFITS for Full and Part-time employees who work 30 or more hours per week:

We pay 100% of the MEDICAL monthly premiums for Employee Only coverage.

We pay 100% of the DENTAL monthly premiums for Employee Only coverage.

We provide an affordable VISION monthly premium for Employee + Family coverage.

We pay 100% of BASIC LIFE for a benefit amount of $10,000.

We offer safe harbor matching contributions for the 403(B) RETIREMENT SAVINGS account.

We offer up to fifteen (15) days of PAID TIME OFF based on paid hours per pay period.

We offer eleven (11) company-observed PAID HOLIDAYS.

We offer education and TUITION REIMBURSEMENT.


We offer MILEAGE REIMBURSEMENT.

Bienvivir is currently accepting applications for the following position:

MEDICAL RECORDS REVIEWER

The Medical Records Reviewer works under the general supervision of the Medical Records (MR) Supervisor, is responsible for complying with and enforcing organization and department policies and procedures, the National PACE Association (NPA) standards, Center for Medicare & Medicaid Services (CMS) regulations, HIPAA requirements, and Electronic Medical Record (EMR) guidelines. Responsible for data entry and audits to ensure medical records are accurately documented, securely stored, and accessible to authorized users in compliance with healthcare regulations. Duties include scanning and organizing documents into the EMR, properly categorizing and labeling records, processing record requests, preparing and releasing medical records to nursing home facilities, and maintaining confidentiality and security. Additional duties include covering MR staff responsibilities, assisting with training, and performing administrative, clerical, and project-based tasks.

RESPONSIBILITIES:
1. Responsible for data entry into the EMR. Effectively scans, uploads, and audits all relevant paper and electronic documents into the EMR.
a. Audits documents for accuracy, completeness, and relevance; perform data entryin the EMR as required.
b. Follows EMR and scanning program guidelines in accordance with Compliance and MR policies and procedures.
c. Reviews and prepares paper documents for scanning and/or uploading. Review electronic documents to ensure completeness, accuracy, and correct categorization before uploading them to the EMR. Performs audits as needed.
d. Identifies and resolves discrepancies by coordinating with appropriate MR staffbefore uploading documents to the EMR.
e. Serves as backup for uploading electronic progress notes to the EMR.
f. Assists in auditing electronic progress notes uploads.
g. Manages the electronic lab process by processing results from contracted laboratories for all centers and promptly entering lab data into the EMR. Maintains tracking logs and ensures timely documentation.
2. Responsible for collecting information related to participants' inpatient stays, emergency room visits and completes the Service Utilization Report (SUR).
a. Collects and tracks hospitalization data from interdepartmental meeting minutes.
b. Audits, reviews, and processes hospital medical records, ensuring accuracy, completeness, and relevance before scanning and/or uploading them to the EMR.
c. Maintains updated logs to reflect any changes affecting data entry or reporting.
d. Prepares and submits weekly hospitalization data to the MR Coordinators for entry into the EMR, providing the information required for SUR processing.
e. Collaborates with MR Coordinators to resolve discrepancies in received medical records when information does not match what was reported.
3. Responsible for processing medical records for Visitors.
a. Completes the entry of both electronic and paper Visitors documents into the EMR. Processes and pre-audits visitor medical records for storage in the network file share and upload them into the EMR.
b. Maintains an up-to-date visitor tracking log.
c. Ensures all visitor records are saved in the network file share and accurately labeled and categorized in their appropriate folders.
d. Maintains and organizes the visitors purge folder in accordance with record retention policies.
e. Contacts external facilities to cancel medical record requests based on visitor disposition and complete the record disposition process as required.
4. Responsible for initiating, verifying, and tracking medical record requests for participants' hospitalization stays, emergency room visits, and visitors' previous medical history in compliance with departmental and regulatory standards.
a. Contacts the Billing Departments of external facilities to verify admission and discharge dates, emergency room visits, and facility names.
b. Initiates medical record requests by preparing and faxing the request form, tracks, follows up on pending records and keeps the ER/Hospital tracking log up to date.
c. Contacts external facilities to verify and request visitor medical records, using the information provided in the visitor's authorization for release of information form.
d. Tracks and follows up weekly with external facilities on pending record releases to obtain visitor records prior to their scheduled appointments with Bienvivir Primary Care Providers. Maintains an up-to-date visitor tracking log.
5. Responsible for preparing and auditing medical records to be sent to Nursing Home Facilities upon admission and monthly thereafter for the duration of the participant's stay at the facility in accordance with MR standard operating procedures and Interdisciplinary team (IDT) policy.
a. Retrieves records from the EMR, prepares and audits medical record packets for participants placement admissions, respite stays, and monthly medical records updates to be sent to nursing home facilities and maintains records of the packets sent as a backup documentation.
6. Provides backup support and coverage for MR staff during absences, including the following responsibilities:
a. MR Reviewer: Performs all duties associated with this role as needed.
b. MR Progress Notes Specialist: Completes electronic progress note processes and manages the mail-out process for nursing home facilities.
c. MR Coordinator: Attends daily morning meetings and documents meeting minutes and center updates.
7. Meetings:
a. Attends the organization and department staff meetings, training, and in-services (for missed meetings staff are responsible for checking with the MR Supervisor to obtain information).
8. Additional Duties as Assigned:
a. Prepares and submits monthly labels requests to ensure adequate inventory.
b. Must actively participate in assigned cross-training within the MR Department.
c. Performs various projects and clerical duties as assigned.

QUALIFICATIONS / REQUIREMENTS:
1. High school diploma or GED equivalent required.
2. Certified from an accredited technical/trade school in the medical field preferred.
3. Two (2) years of work experience in the medical field preferred.
4. Experience with electronic health records programs, scanning procedures, and familiarity with HIPAA, CMS, TMHP and other regulatory requirements preferred.

Required Skills

KNOWLEDGE, SKILLS, AND ABILITIES:
1. Knowledge of HIPAA, Electronic Medical Record (EMR) systems, and compliance standards related to management, privacy, release, and disclosure of medical records preferred.
2. Extensive medical terminology and clinical documentation knowledge.
3. Quality assurance, attention to detail, and analytical skills.
4. Strong data entry and typing skills, fast and accurate.
5. Computer skills. Competence in organizing and accessing electronic health records; skilled in Microsoft Office applications (Word, Excel, Outlook).
6. Effective communication and telephone skills, courteous and professional interactions with internal and external stakeholders.
7. Good judgment, excellent problem-solving abilities, and decision-making skills.
8. Ability to follow directions, instructions, policies, and procedures in any format, including verbal and written.
9. Ability to manage multiple tasks efficiently, prioritize responsibilities, follow up on pending work, and meet deadlines. Advanced organization and time management abilities.
10. Ability to work independently and as a team member. Ability to maintain effective working relationships with staff at all levels.