Required: 3+ years of experience in medical records, health information management, or related healthcare/behavioral health operations preferred.

Overview
The Medical Records Administrator oversees daily operations within the medical records department, ensuring that patient health information is accurately maintained, securely protected, and readily available for authorized use in compliance with HIPAA and payer requirements. The position leads the distribution and monitoring of medical records workload, supports staff through clear communication and quality oversight, and drives efficient, compliant workflows across the department. In addition to these core responsibilities, this role provides specialized support to appeals and clinical services, including coordinating documentation for payer appeals, clinical reviews, and other non-clinical administrative needs of the clinical team.

Responsibilities

Coordinate, delegate, and monitor daily workflow among the medical records team (onshore and offshore) to meet departmental goals and turnaround times.
Oversee department communication with facilities, clients, and payers, including shared inboxes, messages, and portals, ensuring timely, professional responses and resolution.
Review workload distribution and adjust assignments based on staffing levels, volume, and priority, managing overflow during peak periods.
Process and QA medical records to verify completeness, accuracy, appropriate indexing, and compliance with regulatory and payer requirements.
Prepare and submit finalized record packets and supporting documentation via approved transmission methods (portal, secure email, fax, mail) and maintain accurate logs and confirmations.
Monitor record status across all work queues, follow up on missing or delayed records from facilities, and reconcile mail, fax, and electronic logs for accuracy and completeness.
Conduct routine quality audits of records completed by the team; provide clear feedback, coaching, and corrective actions to onshore and offshore staff.
Collaborate with staff to resolve charting issues, documentation gaps, and errors, and escalate complex or high-risk cases to leadership as needed.
Maintain and update medical records SOPs, workflows, templates, training materials, and reference documents to support consistency and compliance.
Track and report key metrics such as volume, turnaround times, QA error rates, and outstanding requests, using data to drive workflow improvements.
Handle administrative processes related to scheduling, meetings, and departmental reporting, representing the department in a professional and solutions-focused manner.
Print, assemble, scan, and upload documentation as required, always ensuring secure handling and storage of PHI.
Assist leadership with preparing and maintaining departmental administrative records related to staffing, timekeeping, productivity, and other operational reporting.
Promote a culture of confidentiality, HIPAA compliance, risk awareness, and professional conduct across the team; participate in trainings and in-service activities as required.
Coordinate documentation collection and organization for payer appeals, clinical chart reviews, and related audits, ensuring that all required claims and records are captured, correctly routed, and presented in a clear, cohesive manner.
Review medical records in detail to synthesize timelines, services, and clinical rationale into well‑structured appeal narratives and supporting packets that accurately reflect the patient’s course of care and the provider’s intent.
Manage documentation requests related to appeals and clinical reviews (e.g., progress notes, assessments, treatment plans, ancillary records), identifying requests that are inappropriately routed to the medical records team and redirecting them to the appropriate department with clear, timely communication.
Provide thoughtful, value‑adding feedback to leadership, clinical teams, and facilities on documentation and workflow opportunities that can strengthen medical‑necessity support, improve the quality of appeal submissions, and reduce the likelihood of future denials, while adhering to internal guidelines and scope of practice.
Support appeals and clinical consultative services by participating in case discussions and client‑facing conversations as requested, carefully framing recommendations within established internal guidance and helping clients understand options, risks, and best‑practice considerations for optimizing clinical and operational outcomes.
Complete all assigned tasks in a timely manner while keeping the manager informed of issues, risks, and resource needs; perform other related duties as assigned.

Skills

Comfortable with Outlook functions (Outlook mail, Teams, One Drive, etc.)
Proficiency with Microsoft Suite (Excel, Word, PowerPoint, etc.)
Working knowledge of payer documentation requirements, HIPAA, and behavioral health terminology.
Perform the essential functions and physical demands of the position with or without accommodation.

Education and Experience

High school diploma or equivalent required; associate's degree or higher in health information, healthcare administration, or related field preferred.
3+ years of experience in medical records, health information management, or related healthcare/behavioral health operations preferred.
Experience working with EHR/EMR systems, Payer Portals, and online databases.
Experience supporting utilization review, appeals, or clinical documentation review strongly preferred.

Pay: $45,000.00 - $50,000.00 per year

Experience:

Medical records: 3 years (Required)
Health information management: 3 years (Required)
Behavioral health: 3 years (Required)
Utilization review: 3 years (Preferred)

Work Location: Remote

Nextus Billing Solutions

New Jobs

Medical Records Specialist: Behavioral health