Medical Records Specialist

SUMMARY:

The Medical Records Specialist is responsible for managing and responding to all external medical records requests for a behavioral health agency within the company. This role ensures full compliance with HIPAA, 42 CFR Part 2, Ohio Department of Mental Health and Addiction Services (OhioMHAS/ODMHAS), and payer-specific documentation requirements.

A key function of this position is preparing responses for payer audits, including demonstrating medical necessity using ASAM criteria and supporting documentation for all dates of service under review. The specialist maintains accuracy, confidentiality, and regulatory compliance across all record-handling activities.  The specialist monitors and responds to audit responses and implements action items as needed.

 ESSENTIAL FUNCTIONS:

Medical Records Management with Regulatory Compliance

·        Ensure compliance with HIPAA and the heightened confidentiality requirements of 42 CFR Part 2 for mental health and substance use disorder records.

·        Receive, review, and process all external, third‑party, or payer‑initiated medical records requests that are not driven by the client and do not fall under treatment team‑managed ROI releases (e.g. payer audits, quality reviews, legal inquiries, government/regulatory requests).

·        Validate authorization forms and ensure all releases meet federal and state confidentiality laws.

·        Collect, organize, and oversee provision of behavioral health records including therapy notes, assessments, medical evaluations, treatment plans, and discharge summaries.

·        Maintain detailed tracking and documentation of all external records disclosures for compliance and audit readiness.

Payer Audit Support & Medical Necessity Responses with Quality Record Support

·        Serve as the primary coordinator for payer audits (Medicaid, Medicare, managed care organizations, commercial insurers).

·        Compile, prepare, and submit complete and accurate medical records for all dates of service being audited.