Medical Records

ODYSSEY BEHAVIORAL GROUP•Deerfield Beach, FL

7d•Onsite

About The Position

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.

Requirements

High School Diploma or GED required, Associate’s or bachelor’s degree in health information management, Healthcare Administration, or related field preferred. Minimum of 2 years in medical records, health information management within a behavioral health or healthcare setting. Experience with payer appeals and electronic health record systems preferred.
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.
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.

Responsibilities

Gather patient demographic and personal information.
Issue medical files to persons and agencies according to laws and regulations.
Ensure patient charts, paperwork, and reports are completed in an accurate and timely manner.
Make sure all medical records are protected and kept confidential.
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.
Receive, log, and process all requests for clinical documentation, including those from clients, family members, referents, insurance payers, attorneys, auditors, and internal departments.
Verify appropriate authorization for release of information (ROI) prior to disclosure and ensure all releases are documented in the client record.
Pull, compile, and redact clinical documentation as needed, ensuring accuracy, completeness, and adherence to confidentiality policies.
Track and respond to record requests within required timeframes, maintaining detailed logs of all outgoing disclosures.
Coordinate with clinical and administrative staff to retrieve or clarify missing or incomplete documentation.
Maintain and update record retention, storage, and destruction logs per policy and legal standards.
Work closely with Utilization Review staff to assemble documentation for written insurance appeals related to denials, level-of-care determinations, or medical necessity disputes.
Submit and track written appeals, maintaining a centralized appeals log that includes dates, payer, level of care, reason for denial, and final determination.
Ensure all appeal packets are complete, professionally formatted, and compliant with payer and regulatory requirements.
Maintain strict confidentiality of all health information and ensure all recordkeeping activities meet federal and state privacy regulations.
Stay informed of current AHCA, DCF, CARF, and payer documentation standards.
Report any suspected privacy or data breaches immediately to the Compliance Officer.