Vital Care (www.vitalcare.com) is the premier pharmacy franchise business with franchises serving a wide range of patients, including those with chronic and acute conditions. Since 1986, our passion has been improving the lives of patients and healthcare professionals through locally-owned franchise locations across the United States. We have over 100 franchised Infusion pharmacies and clinics in 35 states, focusing on the underserved and secondary markets. We know infusion services, and we guide owners along the path of launch, growth, and successful business operations.

What We Offer

Comprehensive medical, dental, and vision plans, plus flexible spending, and health savings accounts.
Paid time off, personal days, and company-paid holidays.
Paid Paternal Leave.
Volunteerism Days off.
Income protection programs include company-sponsored basic life insurance and long-term disability insurance, as well as employee-paid voluntary life, accident, critical illness, and short-term disability insurance.
401(k) matching and tuition reimbursement.
Employee assistance programs include mental health, financial and legal.
Rewards programs offered by our medical carrier.
Professional development and growth opportunities.
Employee Referral Program.

Job Summary

The role of the Medical Records Specialist is to review and respond to insurance correspondences and provide medical documentation to support accurate reflection of a patient’s clinical status. Perform functions to safeguard and protect the patient's right to privacy by ensuring that only authorized individuals have access to the patient's medical information and that all releases of information comply with the request, authorization, company policy, and HIPAA regulations.

Duties/Responsibilities

Timely produce and deliver medical records in response to third-party payer requests, communicate with franchise partners, and outline needs of any missing documentation to satisfy requests.
Responsible for processing all release of information requests in a timely and efficient manner, ensuring accuracy, and providing customers with the highest quality product and customer service.
Validate requests and authorizations for releasing medical information according to established procedures.
Apply knowledge of medical terminology and clinical expertise to evaluate clinical documents.
Serve as a resource and communicate with franchises and other team members to facilitate or obtain comprehensive medical record documentation to reflect treatment.
Perform quality checks on all work to ensure the accuracy of the release and confidentiality.
Researches, analyzes, recommends, and facilitates a plan of action to correct discrepancies and prevent future documentation discrepancies.
Provide excellent customer service by being attentive and respectful; ensure understanding of customer requests and follow-through as promised; and proactively identify client concerns or problems.
May receive incoming requests, including opening mail, telephone inquiries, and retrieving facsimile inquiries, depending on the needs of the business.
Maintain working knowledge of the existing state laws.
Works independently to meet or exceed productivity and accuracy goals.
Carry out responsibilities of all Vital Care policies and procedures, including HIPAA and state/federal regulations.
Maintain confidentiality, security, and standards of ethics with all information.
Document actions taken within the systems in accordance with Vital Care processes.
Perform other related duties as assigned.

Required Skills/Abilities

Excellent communication skills: listening, speaking, understanding, and writing English to advance reimbursement and collection efforts.
Strong organizational skills with the ability to track and maintain clear, complete records of activities, cases, and related documentation.
Proven knowledge and skill in utilizing the MS Office suite of software and pharmacy applications.
Advanced data entry skills.

Preferred Skills/Abilities

Understanding anatomy and physiology, disease process, medical terminology, and pharmacology.
Proficiency in reading and interpreting medical records, clinical documentation, and insurance correspondence.
Demonstrates ability to research clinical criteria, evaluate them for accuracy and quality, and ensure they meet accepted standards.
Demonstrate ability to appropriately apply clinical criteria to various claims and effectively utilize audit tools.
Knowledge of ICD-10 and CPT/HCPC coding guidelines and terminology.

Education And Experience

High school diploma or equivalent and additional specialized training (Required).
Healthcare experience: +2 years (Preferred).
Licensed practical nurse (Preferred).
Clinical experience and knowledge of complex diseases (Preferred).
Experience in reviewing and interpreting medical records (Preferred).

Physical Requirements

Sitting: Prolonged periods of sitting are typical, often for the majority of the workday.
Keyboarding: Frequent use of a keyboard for typing and data entry.
Reaching: Occasionally reaching for items such as files, documents, or office supplies.
Fine Motor Skills: Precise movements of the fingers and hands for tasks like typing, using a mouse, and handling paperwork.
Visual Acuity: Good vision for reading documents, computer screens, and other detailed work.

Be part of an organization that invests in you! We are reviewing applications for this role and will contact qualified candidates for interviews.

Vital Care Infusion Services is an equal-opportunity employer and values diversity at our company. We do not discriminate on the basis of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans’ status, or any other basis protected by applicable federal, state, or local law.

Vital Care Infusion Services participates in E-Verify.

This position is full-time.

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