Trauma Registrar
About The Position
Manages the trauma registry database system for the Trauma Program. Abstracts data from the medical record; ICD 10 codes the injury location, event, injury diagnoses, and procedures; and performs injury severity scoring of identified injuries. Collects, compiles and presents data regarding the incidence, severity and causes of traumatic injuries, ensuring accuracy, timeliness and accessibility of information. Participates in data quality and inter-rater reliability process. Maintains clinical and/or research databases for identified programs/ specialty clinics. Collects data used for multiple purposes, which may include process improvement activities and clinical effectiveness/research studies. May prepare information for patient/family education and/or participate in community outreach activities.
Requirements
- HS Diploma or equivalent education/experience
- Proficient knowledge of ICD-10 coding
- Ability to review and abstract information from the medical record and/or various external database with high degree of accuracy
- Knowledge of medical terminology, anatomy, and physiology sufficient to evaluate, abstract, and code specific diagnosis and treatment information from patient medical records.
- Data abstraction principles and guidelines, basic math and ability to perform basic analytical calculations.
- Must have working knowledge of regulations regarding confidentiality, release of medical information and the role of regulatory agencies in assigned setting.
- Proven sound judgment and ability to work within delegated authorities.
- Must demonstrate written and verbal interpersonal communication and problem-solving skills, thorough knowledge of English grammar and spelling.
- Ability to read, write, hear, and verbally communicate in English to the degree required to perform the job.
- Computer proficiency in Microsoft software to include Excel, Access and Word.
Nice To Haves
- 1-2 years reviewing and abstracting information from the medical record and/or various external databases.
- 1-2 years working in an acute care hospital setting
- College preparation in Health Information Management
- Successful completion of the American Trauma Society Trauma Registrar Course
- Successful achievement of CSTR certification
- Knowledge of AAAIM Injury Severity scoring
Responsibilities
- Manages the trauma registry database system for the Trauma Program.
- Abstracts data from the medical record
- ICD 10 codes the injury location, event, injury diagnoses, and procedures
- Performs injury severity scoring of identified injuries.
- Collects, compiles and presents data regarding the incidence, severity and causes of traumatic injuries, ensuring accuracy, timeliness and accessibility of information.
- Participates in data quality and inter-rater reliability process.
- Maintains clinical and/or research databases for identified programs/ specialty clinics.
- Collects data used for multiple purposes, which may include process improvement activities and clinical effectiveness/research studies.
- May prepare information for patient/family education and/or participate in community outreach activities.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Industry
Nursing and Residential Care Facilities
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
