Medical Records Assistant

PACS

3d • $18 - $21 • Onsite

About The Position

The primary purpose of your job position is to maintain resident medical records and health information systems in accordance with current federal and state guidelines as well as in accordance with our facility’s established privacy policies and procedures.

Requirements

• Must possess, as a minimum, a high school diploma or GED.
• Must be knowledgeable of medical terminology.
• Be knowledgeable in computers, data retrieval, input and output functions, etc.
• Must be able to read, write, speak, and understand the English language.
• Ability to read technical procedures.
• Must possess the ability to make independent decisions when circumstances warrant such action.
• Must possess the ability to deal tactfully with personnel, residents, visitors and the general public.
• Must possess the ability to work harmoniously with other personnel.
• Must possess the ability to minimize waste of supplies, misuse of equipment, etc.
• Must possess the ability to seek out new methods and principles and be willing to incorporate them into existing practices.
• Be able to follow written and oral instructions.
• Must not pose a direct threat to the health or safety of other individuals in the workplace.
• Must be able to move intermittently throughout the workday.
• Must be able to speak and write the English language in an understandable manner.
• Must be able to cope with the mental and emotional stress of the position.
• Must possess sight/hearing senses or use prosthetics that will enable these senses to function adequately so that the requirements of this position can be fully met.
• Must function independently, have personal integrity, have flexibility, and the ability to work effectively with other personnel.
• Must be able to push, pull, move, and/or lift a minimum of 25 pounds to a minimum height of 5 feet and be able to push, pull, move, and/or carry such weight a minimum distance of 50 feet.
• May be necessary to assist in the evacuation of residents during emergency situations.

Nice To Haves

• A working knowledge of medical terminology, anatomy and physiology, legal aspects of health information, ICD-10 coding, indexing, etc., preferred but not required.
• On-the-job training provided in medical record and health information system procedures.

Responsibilities

• Receive and follow work schedule/instructions from your supervisor and as outlined in our established policies and procedures.
• Assist in organizing, planning and directing the medical records department in accordance with established policies and procedures.
• Assist the Medical Records/Health Information Consultant as required.
• Develop and maintain a good working rapport with inter-department personnel, as well as other departments within the facility, to assure that medical records can be properly maintained.
• Retrieve resident records (manually/electronically). Deliver as necessary.
• Files/scans information such as nurses’ notes, resident assessments, progress notes, laboratory reports, x-ray results, correspondence, etc., into resident charts.
• Collect, assemble, check and file resident charts as required.
• Assist MDS Coordinator in scheduling assessments in accordance with current facility and OBRA guidelines.
• Maintain a record of authorized information released from charts/records, i.e., type information, name of recipient, date, department, etc.
• Abstract information from records as authorized/required for insurance companies, Medicare, Medicaid, VA, etc. in accordance with current Privacy Rules.
• Index medical records as directed by the medical records/health information consultant.
• Collect charts, assemble them in proper order, and inspect them for completion.
• Pick up and deliver resident medical records from wards, nurses’ stations, and other designated areas as necessary.
• Batch resident information into the computer and retrieve resident demographic information as appropriate or as instructed.
• Answer telephone inquiries concerning medical records functions. Prepare written correspondence as necessary.
• Retrieve medical records when requested by authorized personnel (i.e., physicians, nurses, government agencies and personnel, etc.)
• File active and inactive records in accordance with established policies.
• Agree not to disclose resident’s protected health information and promptly report suspected or known violations of such disclosure to the Administrator.
• Report any known or suspected unauthorized attempt to access facility’s information system.
• Input physician orders on admit and code diagnosis using ICD-10 coding guidelines
• Report known or suspected incidents of fraud to the Administrator.
• Ensure that departmental computer workstations left unattended are properly logged off or the password protected automatic screen-saver activates within established facility policy guidelines.
• Attend and participate in mandatory facility in-service training programs as scheduled (e.g., OSHA, TB, HIPAA, Abuse Prevention, etc.).
• Attend and participate in workshops, seminars, etc., as approved.
• Report all unsafe/hazardous conditions, defective equipment, etc., to your supervisor immediately.
• Report equipment malfunctions or breakdowns to your supervisor as soon as possible.
• Ensure supplies have been replenished in work areas as necessary.
• Assure that work/assignment areas are clean and records, files, etc., are properly stored before leaving such areas on breaks, end of workday, etc.
• Other duties as assigned.

Benefits

• Medical, Dental, Vision
• 401(k) plan with employer match
• Generous paid time off for vacation accruing at 4 hours a month, 48 FT or 40 PT annually
• recurring sick day hours prorated based on hire date, and 7 paid Holidays each year.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED