Medical Records & Authorizations Specialist

About This Role

This role involves managing medical records and authorization programs, ensuring compliance with privacy regulations and internal standards. The specialist will handle sensitive information, resolve complex inquiries, and collaborate cross-functionally to optimize records workflows.

Responsibilities

• Own and oversee end-to-end medical records request workflows, ensuring accuracy, discretion, and regulatory compliance.
• Review and validate authorizations and related documentation, exercising independent judgment to determine eligibility for records release.
• Serve as a cross-functional liaison and primary point of contact for records requests, partnering with members, therapists, legal representatives, and internal teams.
• Maintain and assess audit-ready documentation of requests, actions, deadlines, and communications, identifying and addressing potential compliance gaps.
• Act as an escalation point for complex, urgent, or sensitive requests, partnering with Legal, Compliance, Clinical Operations, and Member Success.
• Proactively manage service-level performance by analyzing request pipelines, identifying systemic blockers, and driving cross-team solutions.
• Identify opportunities for process optimization and risk mitigation, contributing insights and recommendations to improve efficiency, accuracy, and scalability of records operations.
• Contribute to cross-functional initiatives, audits, and special projects within Clinical Operations.
• Oversee secure and compliant records disclosure decisions in alignment with policies, regulations, and evolving operational needs.

Requirements

• Bachelor's or Master's degree in a healthcare-related field
• 2-3 years of experience in medical records or health information management, healthcare billing or revenue cycle operations, or healthcare customer support or operations
• Working knowledge of HIPAA and confidentiality requirements related to PHI
• Exceptional organizational skills with high attention to detail and accuracy
• Excellent written and verbal communication skills
• Ability to manage multiple time-sensitive tasks in a fast-paced environment
• Proficiency with digital platforms and operational tracking systems

Qualifications

• Bachelor's or Master's degree in a healthcare-related field (e.g., Health Administration, Public Health, Health Sciences, Psychology, or similar)
• 2-3 years of experience in medical records or health information management, healthcare billing or revenue cycle operations, or healthcare customer support or operations.

Nice to Have

• Licensed clinician strongly preferred
• Experience working in telehealth, behavioral health, or mental health settings
• Familiarity with electronic health records (EHRs), CRM systems, or case management tools
• Familiarity with audits, utilization review, or medical necessity documentation
• Experience using DocuSign or other electronic consent platforms
• Prior experience handling sensitive, time-sensitive, or legally driven requests, ideally supporting insurance authorizations or payer documentation
• Ability to balance empathy with policy enforcement when communicating with clients
• HIM, ROI, or authorization-related certification

Benefits