Medical Records Technician II

Job Summary:

Maintains and monitors medical record integrity through record organization and management, filing, assembly, analysis and re-analysis (updates), final check retrieval, record control, completion, scanning, index, quality review and overall processing and accounting for any/all patient health information (medical records). Assisting if necessary with charge entry, meaningful use, and release of information functions and other phone and clerical duties within the Health Information Department while maintains HIPAA compliance, confidentiality and security of the patients’ records

Functions and Duties:

• Verification of receipt any/all records and reports to HIS Department per applicable lists identifying patients registered and subsequently receiving service.
• Follow up of any/all records and reports not received in HIS Department.
• Assigns facility fee Evaluation and Management (E/M) charges to Emergency Department records based on nursing and hospital resources used to treat the patient.
• Completes facility fee charging within 24 business hours from date of discharge.
• Prepares sorts, analyze, prep, scan, index and quality review records per established chart order and document type and for completeness the medical records of patients discharged.
• Performs quantitative analysis of each chart and analysis.
• Performs qualitative analysis and final check to identify missing documentation, misfiled information, and /or information and follows up to secure receipt appropriately.
• Performs re-analysis and final check processes of all records until achieve completion status required to route to Permanent File area and updates automated incomplete record system appropriate.
• Understanding of medical terminology and hospital procedures including lab, x-ray and diagnostic services.
• Understands working relationships between nursing, advanced practitioners and ER attending on record.
• Assist with outside correspondence phone calls, and record pulls needed for correspondence while maintaining a 15-day turn-around.
• Actively participates with the scanning and assignment of a deficiency for the coding query to physicians.
• Notes deficiencies to be completed by physician or other professional staff.
• Organizes work time to complete assigned tasks on time.
• Maintains close working relationship with ancillary departments in carrying out medical record functions.
• Communicates clearly and accurately by phone, fax, or email.
• Maintains confidentiality of patients’ records and safeguards privacy of medical record information.
• Performs duties with minimum supervision and uses work time productively.
• Process requests per established ROI/HIPAA/Meaningful use procedures.
• Knowledge and assistance of how to retrieve and print ambulance reports daily.
• Daily completion and maintenance of Index Utility Queue.
• Performs all other duties as assigned.

Minimum Qualifications:

Education

• High school diploma or GED equivalent required.
• Associates degree, preferred.

Experience

• Minimum of 5 years work related medical record experience, preferred.

Certifications, Licenses, and Registrations

• RHIT (Registered Health Information Technician) or eligible, preferred.

Skills and Abilities

• Working knowledge and/or familiarization with computer software (Microsoft Office Applications) and office equipment (copier, calculator, etc).
• Medical terminology.
• Hospital billing and chargemaster experience, preferred.

Touchette Regional Hospital Benefits

• Medical Insurance
• Flexible Spending Account (FSA)
• Health Savings Account (HSA)
• Dental Insurance
• Vision Insurance
• Employee Assistance Program
• Travel Emergency Assistance
• Employer Paid Life Insurance
• Voluntary Life Insurance
• Short Term Disability Insurance
• Long Term Disability Insurance
• 401(k), with Company Match
• Term Life Insurance
• Whole Life Insurance
• Accident Only Insurance
• Cancer Insurance
• Hospital Indemnity Insurance
• Critical Illness Insurance
• Paid Time Off (PTO) Holidays
• Sick Days
• Floating Birthday
• Bereavement
• Jury Duty
• Tuition Reimbursement