Medical Records Specialist

Cantex; Richardson (TX); On-site; USD 42,000 - 65,000; Full time

Benefits offered by this job

401k with match

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

Tuition Reimbursement

CEU Reimbursement

Rewards Program

Job summary

Cantex is seeking a Medical Records Specialist to maintain accurate EMRs, manage physician orders, and ensure regulatory compliance in a Skilled Nursing Facility setting. The role involves chart audits, records requests, and supporting nursing operations with documentation accuracy.

Ideal candidates have MR experience in long-term care, strong computer skills, and familiarity with HCHB. On-site position with competitive wages and benefits, aligned to HIPAA standards.

Qualifications

• RHIT or HS diploma (or equivalent) required at minimum.
• Minimum of one year of medical records experience in a long-term care setting preferred.
• Computer literacy required.
• Knowledge of Homecare HomeBase (HCHB) preferred.
• Ability to read, write, and communicate effectively in English.
• Medical Records & Central Supply exp at Skilled nursing facility.

Responsibilities

• Maintain medical record files and scan into EMR per policies and regulatory requirements.
• Accurately file and maintain patient information within medical records.
• Manage inventory of forms and supplies for nursing stations.
• Prepare correspondence and documentation related to medical records operations.
• Enter physician orders and clinical data into clinical software as applicable.
• Submit orders for physician signatures and track electronic signatures.
• Conduct chart audits to identify deficiencies and communicate findings to physicians and leadership.
• Prepare and distribute daily/weekly/monthly audit reports for records completion.
• Process medical records requests and coordinate releases with counsel when required.
• Ensure discharge records and summaries are completed and stored properly.
• Participate in QA activities and maintain compliance with policies and procedures.
• Attend trainings and perform duties to support medical records operations.
• Maintain patient confidentiality per HIPAA and policies.
• Support agency readiness for audits and inspections.

Skills

Computer literacy

English communication

Medical records experience

Education

RHIT or HS diploma

Tools

Homecare HomeBase (HCHB)

Job description

Medical Record & Central Supplies

The Medical Records Specialist is responsible for maintaining accurate, organized, and compliant medical records in accordance with company policies, OBRA guidelines, and applicable state regulatory standards. This role manages electronic medical records (EMR), physician order documentation, chart audits, records requests, and medical record retention processes while supporting regulatory compliance and documentation accuracy. The Medical Records Specialist serves as a key resource for medical records management, healthcare documentation workflow, and quality assurance activities, and may provide administrative and clinical support to the nursing department as needed. Must have experience with Medical Records and Central Supplies at Skilled Nursing Facility

Responsibilities

• Maintain medical record files and scan documentation into the electronic medical record (EMR) system in accordance with company policies and regulatory requirements.
• Accurately scan, file, and maintain patient information within individual medical records.
• Manage inventory of forms and supplies for nursing stations and prepare spend-down documentation for leadership review.
• Prepare correspondence and administrative documentation related to medical records operations.
• Enter physician orders, patient weights, and other clinical information into clinical software systems when applicable.
• Submit physician orders and interim orders for physician signature and ensure timely receipt of required electronic signatures.
• Conduct chart audits and medical records reviews to identify documentation deficiencies, compliance concerns, and incomplete records, and communicate findings to physicians and clinical leadership.
• Prepare and distribute daily, weekly, and monthly audit reports for review, correction, and completion of required documentation.
• Process medical records requests, maintain records-release logs, prepare documentation for release of information, and coordinate records requests with legal counsel when required.
• Ensure discharge records, discharge summaries, assessments, and related documentation are completed and maintained according to established medical records procedures.
• Participate in quality assurance activities, maintain compliance with clinical policies and procedures, and support patient record management initiatives.
• Attend required training and perform additional duties as assigned to support medical records operations and organizational objectives.
• Maintain confidentiality of patient information in accordance with HIPAA and organizational policies.
• Participate in Quality Assurance and Performance Improvement (QAPI) activities as assigned.
• Support agency readiness for audits, surveys, payer reviews, and regulatory inspections.

Qualifications

• Registered Health Information Technician or high school graduate (or equivalent).
• Minimum of one year of medical records experience in a long-term care setting preferred.
• Computer literacy required.
• Knowledge of Homecare HomeBase (HCHB) preferred.
• Ability to read, write, and communicate effectively in English.
• Medical Records & Central Supply exp at Skilled nursing facility

Benefits/EEO

• Competitive Wages
• 401k with match
• Medical, Dental, Vision & Supplemental Insurance
• Vacation, Sick, Personal Holiday & Paid Holidays
• Short-Term Disability
• Life Insurance
• Tuition & CEU Reimbursement
• Rewards & Recognition Program

What We Offer You

• Competitive Wages
• 401k with match
• Medical, Dental, Vision & Supplemental Insurance
• Vacation, Sick, Personal Holiday & Paid Holidays
• Short-Term Disability
• Life Insurance
• Tuition & CEU Reimbursement
• Rewards & Recognition Program

EEOC

We are an Equal Opportunity Employer. We offer an excellent benefit plan to include 401(k) with match, CEU reimbursement, vacation, sick time, holidays, medical, dental, and supplemental insurance plans, as well as a highly competitive compensation package.