Medical Records & Intake Assistant / Home Health Aide

Big Sky Home Health, Palliative & Hospice•Bozeman, MT

1d•Onsite

About The Position

This role combines the responsibilities of a Medical Records & Intake Assistant and a Home Health Aide (CNA). The Medical Records & Intake Assistant is responsible for managing patient records, data entry, coordinating patient intake, and supporting agency operations. This includes maintaining confidentiality, communicating with various stakeholders, managing mail, performing administrative tasks, and ensuring accurate record-keeping for billing and compliance. The Home Health Aide (CNA) provides direct patient care under the supervision of a registered nurse or therapist, performing personal care services, assisting with daily living activities, monitoring patient condition, and documenting care provided. Both roles are integral to ensuring quality, continuity, and safety of patient care within the home health setting.

Requirements

Medical records management
Data entry
Maintaining patient records
Preparing for meetings
Answering and directing telephone calls
Coordinating patient intake
Managing workflow in Home Care Home Base
Establishing and maintaining positive relationships with internal staff, clinical field employees, contract staff, patients/families, referral sources, etc.
Responding to staff requests/concerns
Maintaining information to assist in the coordination of patient services and staff availability
Managing all aspects of the patient intake process
Maintaining and protecting organization clinical records
Supervision by a registered nurse or therapist
Performing personal care services
Observing patients
Reporting observations
Documenting observations and care performed
Competency evaluation program completion
Participation in the interdisciplinary team
Assisting with ambulation and exercise
Performing range of motion and other simple procedures
Assisting patient in self-administration of medication
Meeting safety needs of patients and using equipment safely and properly
Adhering to Organization's documentation and care procedures and standards of personal and professional conduct.
Attend 12 clock hours of in-service training annually during a 12-month period.
Attend scheduled Case Conference meetings.

Nice To Haves

Certified Nursing Assistant (CNA) certification

Responsibilities

Maintains confidentiality of patient information.
Assists the Intake department with entering and coordinating new patient referrals.
Maintains accurate up to date medical records in accordance with regulations of Medicare and the Policy and Procedure Manual.
Communicates effectively on the telephone with patients, families and staff.
Answers incoming calls and forwards to appropriate staff person or takes a message if the person is not available.
Welcomes and assists all guests.
Manages incoming, outgoing and interoffice mail.
Performs typing, faxing and copying tasks as requested for various staff persons.
Inputs data into computer for billing purposes.
Orders and maintains accurate records of medical equipment and supplies.
Responsible for informing staff of any changes, updates, etc., regarding admissions; discharges, visits, schedules; and clinical meetings as directed by the Program Director, Director of Clinical Services and/or Administrator.
Tracks admission, discharge, IDTs, certification and re-certification dates on all patients.
Responsible for assisting with audits of patient information.
Maintains accurate mailing lists of employees; patients; volunteers, Medical Directors, physicians and nursing facilities and forwards any changes to the Corporate Office.
Protects the confidentiality of patient and organization information through effective controls and direct supervision of clinical records.
Forwards copies of clinical records to authorized users according to policy.
Monitors aged unsigned physician orders and submit second and third requests for signed orders to overdue physicians, calls or visit the offices of seriously overdue physicians.
Completes an administrative record audit following patient discharge and forwards abnormal results to the Clinical Director or their designee for clinical audit.
Ensure accurate and prompt filing and retrieval of clinical records.
Performs other necessary functions/duties as assigned by the Executive Director.
Providing personal care including: Baths, Back rubs, Oral hygiene, Shampoos, Changing bed linen, Assisting patients with dressing and undressing, Nail & Skin care to prevent breakdown, Assisting the patient with toileting activities, Keeping patient’s living area clean and orderly, as appropriate.
Planning and preparing nutritious meals.
Assisting in feeding the patient, if necessary.
Taking and recording oral, rectal and axillary temperatures, pulse, respiration and blood pressure when ordered (with appropriate completed/demonstrated skills competency).
Assisting in ambulation and exercise according to the plan of care.
Performing range of motion and other simple procedures as an extensional therapy service as ordered (with appropriate completed/demonstrated skills competency).
Assisting patient in the self-administration of medication.
Doing patient’s laundry, as appropriate.
Meeting safety needs of patients and using equipment safely and properly (foot stools, side rails, etc.).
Reporting on patient’s condition and significant changes to the assigned nurse.
Adhering to the Organization's documentation and care procedures and standards of personal and professional conduct.
Attend 12 clock hours of in-service training annually during a 12-month period.
As part of the Interdisciplinary Group (IDG), attend scheduled Case Conference meetings to discuss patients in which you are involved in.