Medical Records Audit Specialist (Zealie)

Roles and Responsibilities

Job Summary

The Medical Record Specialist is responsible for managing and maintaining patient medical records to ensure accuracy, completeness, and confidentiality. This role involves organizing, filing, and retrieving medical documentation, ensuring compliance with regulatory standards, and safeguarding patient information in both electronic and paper formats. The specialist will work closely with healthcare providers, administrative staff, and patients to facilitate the proper handling of medical records and support effective healthcare delivery. Key duties include record retrieval, quality assurance, regulatory compliances. The ideal candidate will possess strong organizational skills, attention to detail, and a thorough understanding of privacy laws and medical record management practices.

Responsibilities and Duties

• Ensure Medical records are provided in a complete and timely manner.

• Be familiar with medical necessity for all payers.

• Use multiple EMR systems to gather Medical Records .

• Follow up on Medical records submission to confirm they have been received

• Review and determine accuracy of demographics , Insurance and billing data

• Cross reference billing and authorization software to ensure accuracy in billing submissions prior to submitting Medical records

• Work with insurance carrier in order to provide proper documentation and reach a resolution

• Maintain and organize patient file documentation .

• Document appropriate follow up notes on accounts and keep meticulous notes in Zealie Zion as required

• Demonstrate customer service skills with the ability to effectively communicate with Internal and external customers and adequate computer skills to be proficient in daily job functions

• Maintains confidentiality of all patient care information to assure patient rights are protected

• May assist in other departmental duties including claim follow up .

Qualifications and Skills

• Strong attention to detail and organizational skills.

• Proficiency with electronic health record (EHR) systems and medical coding.

• Knowledge of medical terminology and healthcare regulations.

• Excellent communication and interpersonal skills.

• Ability to handle sensitive information with discretion.

• Experience working with payer portals

• Medical Terminology

• Record Scanning and Review

• Experience in Revenue Cycle Management

Education and Experience

• High school diploma or equivalent; associate’s degree in health information management or related field preferred.

• Experience in EHR and Medical Billing

Preferred

• Experience working in a behavioral health billing setting

• Knowledge of Substance abuse and Mental Health Treatment Industry