Medical Records Clerk - Home Care organizes, files, and retrieves patient medical records for a home care office. Files various medical documentation, including patient notes, radiology reports, and lab results. Being a Medical Records Clerk - Home Care performs related clerical duties. May be responsible for clerical duties related to patient admission/discharge. Additionally, Medical Records Clerk - Home Care works with both paper-based systems and electronic medical records (EMR). Typically requires a high school diploma or its equivalent. Typically reports to a supervisor or manager. The Medical Records Clerk - Home Care possesses a moderate understanding of general aspects of the job. Works under the close direction of senior personnel in the functional area. May require 0-1 year of general work experience. (Copyright 2024 Salary.com)
Responsible for maintaining resident medical records in accordance with State and Federal regulations, professional standard of practice and company policy and procedure. Responsible for ensuring the management and accuracy of medical resident records from pre-admission to post discharge.
GENERAL DUTIES
• Manages resident health information by ensuring resident records remain accurate, complete, current, confidential, and are compliant with federal and state regulations, HIPAA, and company policies and procedures.
• Ensures accurate and current diagnostic coding to assure appropriate billing, to maximize accounts receiving and improve cash flow.
• Establishes and executes procedures in the collection, coding and indexing, and the filing/retrieving of medical records; Performs ICD coding; creates medical records for all new admissions.
• Must be knowledgeable on federal and state laws regarding medical records; Ensures resident records are maintained accurately and timely according to local, state and federal regulations; Performs monthly audits on: admissions, discharge and routine Quality Assurance
• Ensures that registries are properly maintained for admission and discharge of residents.
• Protects medical records from breaches of confidentiality.
Manage resident appointments and transportation.
QUALIFICATIONS
• Minimum of 2 years’ experience in medical records in skilled nursing facility or healthcare related field.
• Experience with ICD coding preferred.
• Knowledgeable of medical terminology, laws, and regulations, as they pertain to long term care.
• Possess effective communication skills to maintain positive relationship with residents, families, staff, physicians, consultants, providers, and governmental agencies, their representatives and the community.
• RHIA or RHIT credential preferred.
BENEFITS
· 401K
· Annual evaluations
· Dental insurance
· Disability insurance
· Electronic documentation
· Employee appreciation events
· Health insurance
· Life insurance
· Modified Comp
· Paid time off
· Tuition reimbursement
· Vision insurance
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