Medical Records Specialist

Its your choice, choose AdvancedHEALTH. AdvancedHEALTH specializes in medical billing services, accounts receivable, and information management for medical practices. Join our growing team. We promote a fun and friendly work environment. We encourage work/life balance, and we offer competitive wages and benefits.

The Medical Record Specialist is responsible for managing, processing, and fulfilling medical record requests received from third-party vendors, healthcare providers, auditors, government agencies, and other authorized entities. This role ensures timely, accurate, and HIPAA-compliant release of medical records to support reimbursement, audits, appeals, compliance reviews, and continuity of patient care.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Ans Receive, review, and process medical record requests from:
• Third-party vendors
• Insurance carriers
• Healthcare providers
• Internal departments
• Government agencies
• Recovery Audit Contractors (RAC)
• Commercial and Medicare auditors
• Validate request authenticity and authorization requirements prior to releasing records.
• Retrieve medical records from electronic health record (EHR), document management, and imaging systems.
• Compile, review, and submit complete and accurate medical documentation in response to:
• Medical record requests
• Audit requests
• Additional Documentation Requests (ADR)
• Pre-payment and post-payment audits
• Claims appeals and denials
• Monitor request status and ensure all submissions meet established turnaround time requirements.
• Maintain detailed logs and tracking reports of incoming and completed requests.
• Collaborate with providers, coding teams, billing departments, compliance teams, and payers to obtain missing documentation.
• Ensure compliance with HIPAA, CMS guidelines, state regulations, organizational policies, and release-of-information requirements.
• Research and resolve issues related to incomplete, duplicate, or denied record requests.
• Respond to provider inquiries regarding submitted requests and audit documentation.
• Maintain confidentiality and security of protected health information (PHI).
• Assist with process improvement initiatives to enhance productivity, compliance, and customer service.

QUALIFICATIONS:

KNOWLEDGE, SKILLS, ABILITIES:

• Ability to handle high call volumes and multitask effectively
• Proficiency in computer systems and electronic health records (EHR)
• Detail-oriented with strong organizational skills
• Strong knowledge of medical billing and coding practices
• Familiarity of ICD-10, CPT, HCPCS
• Strong Insurance Knowledge
• Must demonstrate strong analytical skills and proficiency with Microsoft office products
• Must have strong critical thinking skills
• Maintains effectiveness when experiencing major changes in work tasks or the work environment
• Ability to work independently without close supervision
• Ability to exercise judgement and make decisions
• Ability to perform in a high productivity, fast-paced environment
• Interpersonal skills and conflict resolution
• Attention to detail
• Excellent phone and computer skills
• Ability to maintain sensitive information in confidence
• Ability to meet deadlines and prioritize responsibilities
• Ability to train staff and write protocols and training materials
• Strong ability to uphold organizational values, work with integrity and ethically, inspire the trust of others, and treat people with respect
• Strong HIPAA and OSHA knowledge

EDUCATION / EXPERIENCE:

• High School or Equivalent
• Minimum of 1-3 years experience in medical billing preferred

WE OFFER:

• Medical Insurance, Dental, & Vision
• Health Savings Account
• Flex Spending for child care
• Paid life insurance of $50,000
• Paid Long Term Disability Insurance
• Voluntary Life Insurance
• Voluntary Short Term Disability
• Many Aflac Policies: Accident, Hospital, Critical Illness, Identity Theft, Legal Plan
• 401K very generous plan the company contributes even if you do not
• PTO (Paid Time Off) generous plan

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