Medical Records Director

PACS

1d•$90,000 - $100,000

About The Position

Peninsula Post Acute is seeking an experienced, detail-oriented Medical Records Director to oversee its medical records department and ensure resident health information is accurate, secure, confidential, and compliant with HIPAA and applicable state and federal requirements. The role supports complete and timely resident documentation, survey readiness, quality resident care, and regulatory compliance in a skilled nursing or long-term care setting. The Medical Records Director oversees records management and electronic health record systems, conducts audits, develops and maintains policies and procedures, and coordinates documentation processes with nursing, rehabilitation, administrative departments, and outside requestors. The position also supervises and supports medical records staff as applicable, provides training and guidance, coordinates schedules, and works with facility leadership to improve departmental performance. This is a full-time position in Burlingame, California, with an annual salary of $90,000–$100,000 depending on experience.

Requirements

Previous medical records experience.
At least 2 years of experience in medical records or health information management.
Strong knowledge of HIPAA, Medicare/Medicaid documentation standards, and skilled nursing facility regulations.
Experience working with electronic health record systems and Microsoft Office.
Strong organizational, communication, leadership, and problem-solving skills.
Ability to manage multiple priorities, meet deadlines, and maintain accuracy in a fast-paced healthcare environment.
Commitment to confidentiality, regulatory compliance, and quality documentation.

Nice To Haves

Skilled nursing or long-term care experience.
Associate or bachelor's degree in Health Information Management.
RHIT certification or a similar health information management credential.

Responsibilities

Oversee the creation, organization, maintenance, storage, and retrieval of resident medical records in compliance with HIPAA and applicable state and federal regulations.
Ensure timely and accurate documentation of resident admissions, discharges, transfers, assessments, and clinical updates.
Monitor medical records for completeness, accuracy, and compliance with facility policies and regulatory requirements.
Coordinate with nursing, rehabilitation, and administrative departments to ensure documentation is completed accurately and on time.
Manage medical-record requests from residents, families, legal representatives, healthcare providers, and authorized agencies.
Oversee electronic health record systems and resolve documentation issues as needed.
Conduct routine medical records audits and prepare reports for internal reviews, external audits, and regulatory inspections.
Maintain confidentiality and safeguard protected health information.
Support facility survey readiness and respond to documentation-related inquiries from regulatory agencies.
Develop, implement, and maintain medical records policies and procedures.
Identify opportunities to improve documentation accuracy, workflow efficiency, and regulatory compliance.
Ensure records are properly indexed, filed, retained, and released according to established policies.
Supervise and support medical records staff, as applicable.
Provide training and guidance on documentation standards, confidentiality, and regulatory compliance.
Coordinate staffing schedules and monitor departmental performance.
Establish expectations for accuracy, timeliness, and adherence to facility policies.
Collaborate with facility leadership to address documentation concerns and improve departmental operations.