Maintain accurate, complete, and up-to-date patient medical records in both physical and electronic formats.
Ensure timely collection, verification, filing, retrieval, and archiving of patient records.
Perform medical coding using standard coding systems (ICD, CPT, or other applicable coding standards) while ensuring accuracy and compliance.
Maintain strict confidentiality of patient information and comply with healthcare privacy regulations and organizational policies.
Enter, update, and validate patient data in the Hospital Information System (HIS) or Electronic Medical Record (EMR) system.
Prepare and maintain medical records, departmental reports, statistics, and other documentation required by management and regulatory authorities.
Assist in internal and external audits by organizing and providing required medical records and documentation.
Support quality improvement initiatives by ensuring the accuracy, completeness, and integrity of medical records.
Coordinate with doctors, nurses, and other healthcare professionals to obtain complete and accurate clinical documentation.
Identify missing or incomplete documentation and follow up with the concerned departments for timely completion.
Ensure proper storage, retention, and disposal of medical records as per statutory and organizational guidelines.
Perform any other duties assigned by the Medical Records Manager or Hospital Administration..
