Medical Records and Data Entry Specialist

Job Description

JOB DETAILS

REQUIREMENTS

• Strong attention to detail and organizational skills.
• Ability to manage multiple tasks and work efficiently in a fast-paced environment.
• Ability to work independently and take ownership of assigned responsibilities.
• Comfortable making outbound calls to healthcare providers and specialty pharmacies to obtain or confirm documentation.
• High school diploma or GED required.
• Availability to work a full-time schedule between 9:00 AM ET and 8:00 PM ET.

Preferred

• Previous experience processing or managing medical records, fax processing, claims entry, or healthcare data entry.
• Familiarity with HIPAA guidelines and medical documentation standards.

RESPONSIBILITIES

• Process, review, and index medical records and supporting documentation to ensure accuracy, completeness, and relevance to members’ therapy plans.
• Ensure that all documents are properly uploaded, categorized, and maintained in the system according to established protocols.
• Enter claims into the system as needed, ensuring accuracy and completeness of all claim information.
• Verify receipt of required documentation by contacting specialty pharmacies or healthcare providers as needed.
• Identify missing information, discrepancies, or incomplete documentation and take appropriate steps to resolve them.
• Make outbound calls to specialty pharmacies or healthcare providers to obtain missing documentation or clarify discrepancies.
• Maintain accurate and organized records, ensuring all information is current and properly documented in the system.
• Process and categorize medical documents to ensure efficient filing, retrieval, and tracking.
• Ensure all records are handled in compliance with privacy and confidentiality standards, including HIPAA requirements.
• Maintain a high level of attention to detail while meeting productivity and turnaround expectations.
• Collaborate with internal teams to support the efficient flow of information and optimal member care.

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