Medical Records

Medical Records Clerk Appeals Specialist

Level Experienced Position Type Full Time Job Shift 1st Shift Education Level High School Travel Percentage None Category Health Care

Description

Since 1991, Lifeskills Behavioral Health has offered customized treatment programs for all genders, ages 18 and over, suffering from mental health conditions and substance use disorders. We provide clinically excellent, evidence-based, and collaborative treatment programs that are tailored based on each client's unique needs to address a variety of mental health disorders as well as substance use disorders. Through our residential treatment program (RTC), partial hospitalization program (PHP), intensive outpatient program (IOP), and transitional living we ensure our clients can successfully transition back into their home life, family life, and careers with newfound self-esteem, direction, and control.

At Lifeskills Behavioral Health, we are a dynamic, dedicated, and growing team of professionals deeply passionate about providing evidence-based and personalized clinical care for mental health disorders and behavioral health conditions.

Since everyone has different experiences with mental health disorders, mental health therapies must be equally unique to address those diverse needs. Working with qualified doctoral level clinicians at Lifeskills gives individuals the opportunity to develop personalized mental health treatment plans that address their needs and help them take the next step in their recovery.

Our team's foundation is client centered care and clinical excellence through our 5-star service commitment – Respect, Accountability, Integrity, Flexibility, Service, and Collaboration. We are committed to our team, and our team is committed to our clients!

Position Summary

The Medical Records Clerk Appeals Specialist oversees the managing of patient health files in a facility. Their duties include filing records, assisting in audits, and collecting information. Clerks ensure medical records are maintained in a manner compliance with ethical, legal and regulatory requirements of the medical services system. Additionally, the medical records clerk supplies the nursing department with the appropriate documents and forms. The Medical Records Clerk and Appeals Specialist is responsible for safeguarding, organizing, and releasing client health records in accordance with all federal, state, and accreditation standards. This role serves as the primary point of contact for all record requests and ensures the accurate, timely, and confidential handling of clinical documentation for clients, families, referents, legal entities, payers, and regulatory agencies. Additionally, the position supports the Utilization Review team by preparing and tracking written insurance appeals.

Relationships and Contacts

Within the organization: Maintains frequent and close working relationships with Clinical staff and facility team members throughout the organization.

Outside the organization : Initiates and maintains strong professional relationships with clients and families, clinical providers, referral partners and vendors, as needed.

Essential Responsibilities

1. Gather patient demographic and personal information.
2. Issue medical files to persons and agencies according to laws and regulations.
3. Ensure patient charts, paperwork, and reports are completed in an accurate and timely manner.
4. Make sure all medical records are protected and kept confidential.
5. Serve as the official custodian of client health records, ensuring proper maintenance, security, and release of information in compliance with HIPAA, AHCA, DCF, and CARF standards.
6. Receive, log, and process all requests for clinical documentation, including those from clients, family members, referents, insurance payers, attorneys, auditors, and internal departments.
7. Verify appropriate authorization for release of information (ROI) prior to disclosure and ensure all releases are documented in the client record.
8. Pull, compile, and redact clinical documentation as needed, ensuring accuracy, completeness, and adherence to confidentiality policies.
9. Track and respond to record requests within required timeframes, maintaining detailed logs of all outgoing disclosures.
10. Coordinate with clinical and administrative staff to retrieve or clarify missing or incomplete documentation.
11. Maintain and update record retention, storage, and destruction logs per policy and legal standards.

Appeals and Clinical Support

1. Work closely with Utilization Review staff to assemble documentation for written insurance appeals related to denials, level-of-care determinations, or medical necessity disputes.
2. Submit and track written appeals, maintaining a centralized appeals log that includes dates, payer, level of care, reason for denial, and final determination.
3. Ensure all appeal packets are complete, professionally formatted, and compliant with payer and regulatory requirements.

Compliance and Quality Support

1. Maintain strict confidentiality of all health information and ensure all recordkeeping activities meet federal and state privacy regulations.
2. Stay informed of current AHCA, DCF, CARF, and payer documentation standards.
3. Report any suspected privacy or data breaches immediately to the Compliance Officer.

Qualifications

Minimum Requirements

Education and Experience

• High School Diploma or GED required; Associate's or Bachelor's degree in Health Information Management, Healthcare Administration, Behavioral Health Administration, or a related field preferred.
• Minimum of two (2) years of experience in medical records, health information management, release of information, or clinical documentation support, preferably in a behavioral health, substance use disorder, mental health, residential, PHP, IOP, or outpatient treatment setting.
• Experience working with behavioral health records and documentation, including assessments, treatment plans, progress notes, discharge summaries, consents, authorizations, releases of information, and payer/audit documentation preferred.

Core Skills and qualifications

• Behavioral health records management, chart maintenance, and clinical documentation support.
• Release of Information (ROI), authorization verification, disclosure tracking, and record request processing.
• Working knowledge of HIPAA, 42 CFR Part 2, confidentiality, and privacy requirements related to mental health and substance use disorder records.
• EHR/EMR documentation workflows, scanning/uploading, record indexing, record retrieval, and documentation quality review.
• Ability to pull, compile, redact, and organize clinical documentation accurately and within required timeframes.
• Understanding of payer, utilization review, appeal, audit, and regulatory documentation needs.
• Familiarity with AHCA, DCF, CARF, and payer documentation standards for behavioral health services preferred.

Additional Requirements

• Valid Florida Driver's License.
• Current CPR and First Aid Certification, or willingness to complete within the first 30 days of employment.
• Clearance of TB test.

Physical Requirements

• While performing the duties of this job, the employee will be required to communicate with peers/general public, clients and/or vendors
• Tolerant to various noise levels: noise level in the work environment varies – may be very quiet to moderate
• Job performance will require the ability to move throughout the building as well as sit or remain stationary for extended periods of time
• While performing the duties of this job, the employee may be required to talk or hear, sit, stand, walk, reach, climb or balance, stoop, kneel, crouch or crawl.
• Ability to move up to 25 pounds

Skill Competencies

• Strong knowledge of HIPAA and confidentiality regulations.
• Familiarity with AHCA, DCF, and CARF standards.
• Ability to manage high volumes of requests while maintaining accuracy and timeliness.
• Excellent attention to detail and organizational skills.
• Proficiency in EHR platforms (e.g., BestNotes) and Microsoft Office Suite.
• Strong written and verbal communication skills.
• Professional discretion and ability to maintain confidentiality in all matters.
• Understands and maintains professional boundaries.
• Demonstrates an understanding of rules/limits of patient confidentiality and maintains appropriate levels of client confidentiality/privacy.
• Demonstrates consideration of and respect for values and cultural beliefs.

Lifeskills Behavioral Health provides equal employment opportunities without regard to race, color, creed, ancestry, national origin, ethnicity, sex, gender, sexual orientation, marital status, religion, age, disability, gender identity, genetic information, service in the military, or any other characteristic protected under applicable federal, state, or local law. Equal employment opportunity applies to all terms and conditions of employment. Lifeskills Behavioral Health reserves the rights to modify, interpret, or apply this job description in any way the organization desires