Medical Records & Data Entry Specialist

Position Summary

A nonexempt position responsible for managing medical records, data entry, and maintaining the accuracy and confidentiality of patient information. This position requires excellent communication skills, attention to detail, and the ability to work in a fast-paced environment.  

Reports To: Front Office Supervisor

Principal Duties and Responsibilities

1. Accurately enter patient information and medical records into the electronic health record (EHR) system
2. Review and verify medical records for completeness, accuracy, and compliance with regulations.
3. Retrieve and process medical records requests from patients, healthcare providers, and other authorized parties.
4. Maintain strict confidentiality of patient information in accordance with HIPAA regulations.
5. Collaborate with healthcare providers and administrative staff to ensure accurate and timely recordkeeping.
6. Perform regular audits of medical records to identify and correct any discrepancies.
7. Review transcriptions/dictations for completed information that is signed by provider.
8. Ensure all transcriptions/dictations are completed within specified deadlines.
9. Priority to enter data within the organization and maintenance of electronic and paper filing processes regarding patient billing/lab charges including but not limited to immunology postings.
10. Assist in the development and implementation of policies and procedures related to medical records, transcriptions, data entry of allergy and immunology postings, and management.
11. Perform regular data audits to identify and correct inconsistencies.
12. Stay up to date with changes within the organization’s medical terminology, coding, and billing practices.
13. Provide support to other administrative staff as required.

 Required Skills, Knowledge, and Abilities

1. Experience with practice management scheduling software, insurance referral and authorization processes, and multi-line telephone systems.
2. Previous experience in medical data entry or a similar role
3. Knowledge of medical terminology, coding, and billing practices within the organization.
4. Proficiency in using electronic health record (EHR) systems.
5. Strong attention to detail and accuracy
6. Excellent organizational and time management skills
7. Ability to work independently and as part of a team.
8. Strong communication skills, both written and verbal
9. Familiarity with HIPAA regulations and patient confidentiality requirements

Education

High school diploma or equivalent; associate or bachelor's degree in a related field preferred but not required.

Experience

At least two years of directly related experience.

Previous experience in medical records management and data entry, preferably in a healthcare setting.

Knowledge of medical terminology, ICD-10 coding, and HIPAA regulations.

Other Requirements

None

Working Conditions

OSHA Category 3: Involves no regular exposure to blood, body fluids, or tissues, and tasks that involve exposure to blood, body fluids, or tissues are not a condition of employment.