Job Description

Medical Records Reviewer

Bienvivir All-Inclusive Senior Health ("Bienvivir") is a community-based, patient-centered, comprehensive health care delivery system that advocates and promotes quality of life, optimum independence, dignity, and choices in a nurturing environment for frail seniors. Since 1987, Bienvivir has served the frail seniors of El Paso, Texas through the provision of the Program of All-Inclusive Care for the Elderly ("PACE"). PACE is a unique managed care benefit for frail seniors (referred to as participants) age 55 and older who are certified by the state as needing nursing home level care and who reside in a PACE service area. PACE programs coordinate and provide comprehensive medical and support services so that participants can remain independent and stay in their homes for as long as safely possible.

The Medical Records Reviewer works under the general supervision of the Medical Records (MR) Supervisor, is responsible for complying with and enforcing organization and department policies and procedures, the National PACE Association (NPA) standards, Center for Medicare & Medicaid Services (CMS) regulations, HIPAA requirements, and Electronic Medical Record (EMR) guidelines. Responsible for data entry and audits to ensure medical records are accurately documented, securely stored, and accessible to authorized users in compliance with healthcare regulations. Duties include scanning and organizing documents into the EMR, properly categorizing and labeling records, processing record requests, preparing and releasing medical records to nursing home facilities, and maintaining confidentiality and security. Additional duties include covering MR staff responsibilities, assisting with training, and performing administrative, clerical, and project-based tasks.

Responsibilities:

• Responsible for data entry into the EMR. Effectively scans, uploads, and audits all relevant paper and electronic documents into the EMR.
• Manages the electronic lab process by processing results from contracted laboratories for all centers and promptly entering lab data into the EMR. Maintains tracking logs and ensures timely documentation.
• Responsible for collecting information related to participants' inpatient stays, emergency room visits, and completes the Service Utilization Report (SUR).
• Responsible for processing medical records for Visitors.
• Responsible for initiating, verifying, and tracking medical record requests for participants' hospitalization stays, emergency room visits, and visitors' previous medical history in compliance with departmental and regulatory standards.
• Responsible for preparing and auditing medical records to be sent to Nursing Home Facilities upon admission and monthly thereafter for the duration of the participant's stay at the facility in accordance with MR standard operating procedures and Interdisciplinary team (IDT) policy.
• Provides backup support and coverage for MR staff during absences.
• Attends the organization and department staff meetings, training, and in-services.
• Additional duties as assigned.

Qualifications / Requirements:

1. High school diploma or GED equivalent required.
2. Certified from an accredited technical/trade school in the medical field preferred.
3. Two (2) years of work experience in the medical field preferred.
4. Experience with electronic health records programs, scanning procedures, and familiarity with HIPAA, CMS, TMHP and other regulatory requirements preferred.

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