Medical Records Specialist

Job Summary/Objective:

The Medical Records Specialist is responsible for managing the medical records of the facility, including preparing, storing, and retrieving patient health records. The Medical Records Specialist reviews medical records for compliance with approved policies, is responsible for their completeness, proper release and maintenance. Works independently or as part of a medical records department.

Essential Job Functions

1. Medical Records Specialists organize and maintain health information both in paper files and in electronic systems. They check data for accuracy, assign codes for insurance reimbursement, record information and keep file folders and electronic databases up to date.

• Prepares new patient charts, gathering documents and information from paper sources and/or electronic health record.
• Ensures medical records are assembled in standard order and are accurate and complete.
• Creates digital images of paperwork to be stored in the electronic medical record.
• Files lab reports, correspondence, physician dictation/notes, progress notes, radiology reports and other approved document, in charts, ensuring they are completed in an accurate and timely manner.
• Ensures that charts for follow-up patients, who are to have testing performed prior to their next visit, are up-to-date with the reports of the test results, and that x-rays are also available.

1. In addition to their clerical duties, Medical Records Specialists often consult with health care professionals to make sure information is accurate. They must also follow best practices for security and patient confidentiality.

• Ensures files are stored in the designated area according to storage procedures.
• Responsible for safeguarding patient records and ensuring compliance with HIPAA standards.
• Ensures fulfillment of all mailed-in and faxed requests for medical records from insurance companies, managed care plans, hospitals, attorneys, patients and other physicians-when appropriate releases are provided
• Answers phone inquiries regarding medical records and performs other clerical functions within the team as designated by supervisor.

THE COMPANY Objectives and Service Standards

The Company prides itself in delivering exceptional service while always exceeding customer expectations. This begins with its employees taking assertive action and building customer relationships and brand loyalty.


Employees have the ability to maintain effective and productive working relationships with fellow employees, supervisors, and clients. They demonstrate the appropriate level of written and verbal communication skills necessary to perform the job, and possess the ability to handle confidential information and think logically and practically prior to making decisions.

Employees demonstrate the value and thoroughness of the work produced, as well as the accuracy, attention to detail and effectiveness of the work completed. The ability to work under pressure and learn from previous mistakes, while accurately checking processes and tasks, as well as handling issues in a timely manner are characteristic of the company's employees. As are the ability to prioritize work and the timely implementation of workable solutions to problems. Employeesdemonstrate thoroughness in following through on tasks and instructions in a reliable, trustworthy, and timely manner. They reveal an overall consistent attendance and adherence to work schedules, office hours, and office demands, and abide to all company policies and procedures.

Supervisory Responsibility
This position has no supervisory responsibilities.


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