Job Title

Pine Ridge Care Center - SUMMARY Responsible and accountable for the record keeping procedures and storage of all clinical records in a manner consistent with facility policies and procedures, professional standards, and state and federal laws and regulations for long-term care facilities. ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned. §   Prepares charts for new admissions. §   Closes medical records upon discharge. ·         Develops schedule for and conducts audits of the clinical and electronic health records. ·         Monitors physician visit schedule. ·         Maintains master index system. ·         Orders, maintains, and distributes medical records forms. ·         Monitors procedures to maintain confidentiality of patient information and guard against loss or destruction of data in accordance with the facility’s policy and procedures. ·         Maintains records and completes required forms and documents in accordance with facility policies and state and/or federal regulations. ENTRY QUALIFICATIONS ·         High school diploma or equivalent. ·         Working knowledge of medical terminology. ·         Proficient in the use of personal computer. SUPERVISORY RESPONSIBILITIES Supervises Medical Record assistant, if any, and others for whom they are administratively or professionally responsible.