Medical Records Specialist

As a Medical Records Specialist , you are the engine behind our financial health, Release of Information (ROI) compliance, and overall operational integrity. You'll be navigating the complexities of the healthcare reimbursement cycle, managing electronic health record (EHR) systems, conducting routine audit readiness reviews, and maintaining strict HIPAA and data privacy protocols. You will act as a vital bridge between our clinics, insurance payers, and third-party requestors to facilitate seamless health information exchange and data interoperability while ensuring patient care is accurately reflected in our billing. This role is based in Flower Mound, TX and will work very closely with multiple departments to ensure strong communication among all stakeholders.

• Medical Records & ROI Workflow Management: Oversee Release of Information (ROI) end-to-end processing, managing incoming and outgoing requests via modern EHR and health information exchange (HIE) platforms, ensuring timely and compliant release to insurance companies, patients, legal entities, and authorized third parties.
• HIPAA, Audit Readiness & Data Privacy Protocols: Maintain full audit readiness and adherence to HIPAA rules, state regulations, and internal privacy policies when handling, releasing, auditing, and archiving protected health information (PHI).
• Strategic Payer Follow-up: Proactively track remits and engage with insurance payers to resolve outstanding issues and ensure timely reimbursement.
• Cross-Functional Collaboration: Collaborate with internal teams to coordinate patient insurance updates, manage claim hold protocols, and support resolution of claim-related issues.
• Queue Management: Effectively prioritize and manage assigned responsibilities within revenue cycle operations while maintaining accuracy and efficiency.
• Revenue Lifecycle Management: Assist with claim submission, adjudication, payment posting, and patient account reconciliation as needed.
• Quality Control: Audit claims for appropriate modifiers and correct billing data points prior to transmission.
• Education: HS Diploma required; Degree in progress or completed preferred.
• Experience: 2 years of Medical Billing/RCM experience (preferred).

Skills

• Deep understanding of medical billing/coding and EMR systems.
• Proficiency in office technology and multi-line phone management.
• Exceptional organizational skills with high attention to detail.
• Strong interpersonal skills for effective team and patient communication.