[Hiring] Medical Records Coordinator @HealthFirst

Role Description

The Medical Records Coordinator supports the accuracy, integrity, and timely management of member records and clinical documentation by performing quality reviews, researching and resolving data discrepancies across multiple systems, managing State Secure File Transfer (SFT) and Uniform Assessment System (UAS) activities, fulfilling regulatory, audit, and legal documentation requests, and supporting appropriate member to Care Manager assignments while collaborating with internal stakeholders to meet operational and regulatory requirements.

Duties & Responsibilities:

• Performs quality checks to maintain the integrity of events and criteria for reporting purposes.
• Processes members’ electronic documents, proof of data for inaccuracies, and any other missing information.
• Resolves discrepancies identified using standard procedures and/or returning incomplete documents to their respective departments for correction and resolution.
• Responds to, monitors, and manages State Secure File transfer inbox; tracking incoming packages and document requests; retrieving and securely transmitting requested PCSP and authorization documentation; completing the monthly disenrollment PCSP transfer process; monitoring and tracking turnaround times to support timely completion of requests.
• Facilitates manual mailings for other departments.
• Maintains enrollment nodes, member demographics, and Person-Centered Service Plan (PCSP) details.
• Conducts data quality reviews by researching and analyzing member records across UAS, internal systems, and source documentation to identify, reconcile, and resolve enrollment, demographic, PCSP, and other data discrepancies.
• Manages documentation pulls for State and regulatory requests, internal audits, and legal inquiries.
• Researches member records across applicable systems to identify, retrieve, review, validate, organize, and prepare accurate and complete clinical documentation ensuring requested records meet established submission timeframe.
• Supports the assignment and reassignment of members to the appropriate Primary Care Manager by reviewing member and case information to determine appropriate care manager alignment based on established assignment criteria, program requirements, and team capacity.
• Researches and resolves assignment discrepancies, processes updates timely, and coordinates with applicable stakeholders to maintain accurate caseloads and continuity of care.
• Additional duties as assigned.

Qualifications

• HS diploma/GED from an accredited institution.
• Proficiency in navigating & working across multiple electronic documentation, healthcare, and database systems simultaneously.
• Experience working with electronic medical records (EMR), protected health information (PHI), or any related healthcare documentation systems.
• Proficiency in Microsoft Excel which includes data entry and editing, search functions, formulas, sorting and filtering, formatting, and using existing pivot tables to research and analyze information.

Requirements

• Strong organizational and time-management skills, with the ability to prioritize multiple assignments, meet deadlines, and follow tasks through to completion.
• Strong research and problem-solving skills, including the ability to navigate online resources and multiple systems to locate, validate, and reconcile information.
• Ability to troubleshoot basic hardware and software issues and effectively communicate technical issues while working with technical support teams to resolve system challenges.
• Experience with data entry and database management, with the ability to accurately maintain, update, and reconcile information across Microsoft Excel and other systems/applications.
• Strong attention to detail and demonstrated ability to perform quality reviews, identify discrepancies, validate information, and ensure data and documentation accuracy.
• Experience working in a healthcare, health plan, managed care, or related environment.
• Knowledge of Medicare, Medicaid, managed care, healthcare terminology, and/or regulatory requirements.
• Ability to exercise sound judgment, investigate discrepancies, identify appropriate next steps, and escalate complex or unresolved issues when necessary.

Benefits

• Medical, dental and vision coverage.
• Incentive and recognition programs.
• Life insurance.
• 401k contributions (all benefits are subject to eligibility requirements).