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Medical Records Clerk

Careers Integrated Resources Inc Williamsburg, VA (Onsite) Contractor
Desired Shift: DAYS - 8HR; Monday - Friday

Job Title: Medical Records Specialist (Onsite) / Medical Records Coder (Onsite)

Purpose:
Responsible for preparing, analyzing, and maintaining medical records to ensure accuracy, completeness, and compliance with confidentiality policies and regulatory standards. May also assign ICD-10 and CPT codes for diagnoses and procedures. This is an onsite position.

Key Responsibilities:
Assemble and analyze medical records for accuracy and completeness.
Manage chart control, storage, and access per policy.
Process requests for medical information and ensure proper authorization.
Handle transcription services and resolve report issues.
Perform quantitative and qualitative analysis of discharge records.
Abstract clinical data for indices and audits.
Maintain Master Patient Index and manage chart inventory.
May assign diagnostic and procedural codes using ICD-10 and CPT.

Requirements:
High school diploma or equivalent required.
Minimum 1 year of experience in medical records within a psychiatric setting.
Prior experience as an abstractor preferred.
RHIT or RHIA certification preferred.

Additional Expectations:
Adheres to organizational policies and confidentiality standards.
Demonstrates cultural values including accountability, collaboration, and respect.
Maintains regular attendance and participates in professional development.
Individual contributor role.

Unit: Psych
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Job Snapshot

Employee Type

Contractor

Location

Williamsburg, VA (Onsite)

Job Type

Health Care

Experience

Not Specified

Date Posted

09/22/2025

Job ID

25-60443

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