Medical Records and Grievance Manager

Job Summary: Under the direction of the Associate Director of Patient Engagement and Services (ADPES), the Medical Records and Grievance Manager (MRGM) of Omni Family Health (Omni) provides administrative and operational support to a growing network of state-of-the-art health centers serving California’s Central Valley. As a member of the organization’s Operations Department, the MRGM is responsible for overseeing the medical records operations and grievance management program, ensuring the integrity, confidentiality, and compliance of patient records and the timely resolution of grievances. The MRGM serves as a key liaison between internal departments and external partners on matters related to medical records and grievance processes.

Job Duties:

1. Oversees the daily medical records operations within the Operations Department, ensuring timely, accurate, and compliant processing, maintenance, and release of patient records across all health centers.
2. Supervises and manages Medical Records staff, including hiring, onboarding, scheduling, performance management, training, and disciplinary actions, ensuring adherence to organizational policies and performance standards.
3. Ensures appropriate staffing levels and workflow coverage, maintaining service standards for document processing, record maintenance, and interdepartmental requests.
4. Monitors and directs medical records workflow, including eFax/document processing, indexing, chart tracking, and release of information functions to ensure efficiency and timeliness.
5. Serves as the primary point of contact for all organizational grievances received from external entities, including health plans, regulatory agencies, and partner organizations.
6. Manages the full lifecycle of grievances, including intake, documentation, investigation, coordination, response, and resolution.
7. Coordinates with internal departments and appropriate stakeholders to gather required information and ensure timely, accurate, and compliant responses.
8. Ensures all grievances are tracked, documented, and resolved within required regulatory and contractual timeframes.
9. Drafts, reviews, and submits formal grievance responses to external organizations in a professional and compliant manner.
10. Analyzes grievance trends and escalates systemic concerns, providing recommendations to leadership for process improvement and risk mitigation.
11. Ensures compliance with HIPPA, state, federal, and accreditation standards (e.g., JCAHO) related to medical records management and grievance processes.
12. Develops, implements, and maintains medical records policies and standard operating procedures (SOPs), ensuring alignment with regulatory requirements and organizational practices.
13. Leads quality assurance and audits activities, including routine monitoring of records integrity, privacy compliance, and departmental performance.
14. Prepares for and supports internal and external audits, regulatory reviews, and inspections, ensuring documentation is accurate, complete, and readily accessible.
15. Serves as a liaison between medical records operations, health centers, IT, and external partners to resolve operational issues, system challenges, and service needs.
16. Maintains relationships with vendors and service providers supporting medical records and document management functions.
17. Coordinates resolution of system-related issues, including collaboration with IT and vendors for electronic health records (EHR) and document management functionality.
18. Leads and supports staff training and professional development initiatives, ensuring ongoing competency in medical records processes, privacy requirements, and grievance procedures.
19. Manages departmental administrative functions, including payroll oversight, scheduling, and operational reporting.
20. Attends management meetings and contributes to organizational initiatives, process improvements, and cross-functional projects.
21. Maintains a safe and compliant work environment, ensuring safety standards and ergonomic practices.
22. Serve as backup support within the medical records operations, as needed to maintain continuity of services.
23. Promotes positive public relations through professional and courteous service.
24. Ensures the department provides cohesive support to the mission, vision, and core values while delivering superior customer service.
25. Works closely with all corporate branches, divisions, and/or departments in accordance with Omni’s policies and procedures.
26. Other duties and/or responsibilities as the MRGM may be assigned from time to time.
27. Some travel may be required.

Additional Duties:

1. Health Insurance Portability and Accountability Act (HIPAA) Compliance: Responsible for maintaining abreast of and in compliance with all HIPAA regulations and requirements.
2. Compliance: Ensures compliance with all local, state, and federal regulations.
3. Quality Assurance/Quality Improvement (QA/QI): Participates as required in QA/QI activities and contributes towards the overall quality improvement initiatives of the organization.
4. Information Technology (IT): May be required to learn and use the electronic health record and its components as required by the job functions and highlighted in the policies and procedures. These components include NextGen, Practice Management System (PMS), Quality Systems Inc. (QSI), and other electronic features as they are developed and implemented, as applicable to work environment.
5. Patient Centered Medical Home (PCMH): All employees will participate in PCMH at Omni Family Health.
6. Audits: Contributes to required Health Resources and Services Administration (HRSA), Operational Site Visit (OSV), The Joint Commission (JC), and other audit events.

Qualifications, Education, and Experience:

1. Bachelor’s degree in Health Information Management, Health Administration, or related field.
2. Certification in medical records through American Health Information Management Association (AHIMA) is preferred, such as Registered Health Information Technician/Administrator (RHIT/RHIA).
3. Six (6) years of experience in medical records, health information management, or related function, with three (3) years in a management position, preferably within a Federally Qualified Health Center (FQHC), healthcare, or nonprofit setting.
4. Experience with grievance and appeal process within a healthcare or managed care environment.
5. Strong knowledge of medical records management, HER systems, and release of information processes.
6. Advanced proficiency in Microsoft Office Suite (Word, Outlook, Excel, Power Point, etc.)
7. Bilingual in English and Spanish preferred.

Skills/Competencies:

1. Communicates effectively (written and verbal). Clearly conveys information and actively listens to understand and respond appropriately.
2. Demonstrates strong analytical and problem-solving skills. Assesses complex issues, conducts investigations, identifies root causes, and develops effective, compliant solutions.
3. Maintains a high level of attention to detail. Ensures accuracy and completeness in medical records, documentation, and regulatory responses, with a strong focus on data integrity and compliance standards.
4. Leads and manages staff effectively. Provides direction, coaching, and accountability to team members; fosters a collaborative environment; and ensures staff performance aligns with organizational expectations and service standards.
5. Applies knowledge of regulatory and compliance requirements. Demonstrates a strong understanding of HIPAA, healthcare regulations, and grievance requirements, ensuring all processes and decisions adhere to legal and organizational standards.

Service Commitments:

1. Must be alert and respect confidentiality of information of all types “general personnel, and/or patient related information.”
2. Promote and believe in OFH mission statement.
3. Ability to relate to the public regardless of ethnic, religious and economic status.

Responsible To: Associate Director of Patient Engagement and Services

Classification: Exempt