Trauma Registrar II - Per Diem

Bassett Healthcare Network•Village of Cooperstown, NY

1d•Onsite

About The Position

The Trauma Registrar II identifies and abstracts trauma cases from the medical record for inclusion in the trauma registry in accordance with American College of Surgeons standards, NYS DOH and other accreditation bodies. This role communicates with EMS agencies regarding collection of missing trauma related pre-hospital data. The registrar abstracts data from the patient’s chart and accurately enters data into the appropriate computerized database in a timely manner, verifying the completeness and integrity of registry data. This position assists in the preparation of trauma information for submission to the NYS DOH and other appropriate regulatory agencies, and assists in the preparation of reports as requested. The role utilizes word processing and spreadsheet applications for communication and record keeping. The Trauma Registrar II participates in the trauma department’s PIPS, QI/QA, and trauma or other related registry conferences as requested. They provide assistance with ATLS, TNCC, ENPC courses and EMS education activities, and maintain confidentiality of trauma related activities. Attendance at Local or State meetings is also required.

Requirements

Experience with computer data entry, databases and spreadsheets, required
Occasional balancing, climbing, crouching, kneeling, lifting, pulling, pushing, stooping, walking
Frequent grasping, standing, visual acuity (color, depth, perception)
Constant typing/clerical/dexterity, hearing, reaching, repetitive motion, seeing/monitor/computer use, talking

Nice To Haves

High School Diploma/GED, preferred
2 Year/Associate Degree, preferred
Associates may be used towards 1 year of experience
Minimum 1 year work experience as a trauma registrar, preferred
Experience with International Classification of Diseases (ICD-10) and CPT coding and billing, preferred
Experience with Abbreviated Injury Scale/Injury Severity Scores (AIS/ISS)
Experience with the institutional trauma registries and electronic medical records, preferred
Certified specialist in trauma registries (CSTR) or One (1) years of experience working with trauma registries in NY State Trauma system. Must obtain within one year of hire, preferred
American Trauma Society’s Trauma Registrar Course or equivalent provided by a state trauma program and Association of the Advancement of Automotive Medicine’s Injury Scaling Course. Must obtain within one year of hire, preferred
AAAM AIS Course Certificate. Must obtain within one year of hire, preferred
ICD-10 Course Certificate. Must obtain within one year of hire, preferred

Responsibilities

Accurately abstracts trauma injury, diagnosis, operative and other pertinent data from patient records
Abstracts clinical data from patient records including pre-hospital, Emergency Department and transfer patient information
Communicates with outside agencies for missing data
Identifies potential trauma related care issues and provides appropriate feedback to Trauma Program Manager, Trauma Program Director or other staff monthly as indicated
Identifies potential coding errors and reports them as indicated
Assists Trauma Program Manager with reports as requested
Reviews actual documentation on trauma patients for accuracy and completeness while abstracting data
Assists with development and implementation of quality management program for trauma services
Maintains the trauma registry and is up to date 90-95% of the time as measured by the Manager on a yearly basis
Maintains the Bassett Trauma Registry by collecting, reviewing, and entering data of patients each year as tracked by the registry
Maintains trauma logs
Maintains confidentiality and security of all patient information in compliance with hospital and federal regulations
Uses quality data to identify potential issues, trends and educational opportunities
Submits timely data to appropriate agencies (NYSDOH, NTDB, TQIP)
Generates and runs reports for QA/PI as required or requested to facilitate continued education and system improvement
Minimum of eight (8) hours of continuing education pertaining to quality management of trauma program
Participates at NY State Trauma Advisory Committee (STAC) and Regional Advisory Trauma Committee (RTAC)
Participates in STAC registrar sub-Committee meetings and attends general session.
Supports research projects as requested
Participates in RTAC meetings and regional PI as required
Builds relationships with other trauma professionals within the state system
Provides program support for injury prevention and EMS education
Participates in local prevention programs as needed
Assists with EMS education programs as needed
Performs administrative duties as needed
Performs other duties as requested and observed by supervisor or manager