Health Info Mgmt Clerk II

Position Title: HIM Clerk II

Department: HIM/or assigned department

Reports To: HIM Supervisor or appropriate site supervisor

POSITION SUMMARY

The HIM Clerk II is responsible for the accurate processing of discharge medical records to assure they are complete, retrievable, protected against unauthorized disclosure and properly indexed by patient, diagnosis, and physician for information retrieval. The HIM Clerk II is also responsible for the accurate entry of patient data into the agency information systems and the implementation of daily and monthly reports. The HIM Clerk II will also respond when necessary to all court orders, subpoenas (facility-wide), and medical record requests for all departments. (OSHPD reporting will be maintained and abstracted by ICD-9CM coding of patient diagnoses and reported electronically, Central Site Only.) The HIM Clerk II will assist the daily maintenance of the medical records for all levels of care.

The HIM Clerk II will train and monitor staff regarding quality of chart content. The HIM Clerk II will process and invoice all medical record requests and provide administration with a monthly billing accounting. The HIM Clerk II will act on behalf of the Supervisor in his/her absence to provide quality care, and assist Program Site Director, as needed with medical records related functions.

HOURS

8 per Day / 5 Days per Week / Hourly

Benefits Package

• Medical Insurance
• Dental Insurance
• Vision Care Plan
• Life Insurance
• Paid Holidays
• Flexible Spending Account (FSA)
• Paid Vacation Time
• Sick Time
• 401(k) Retirement Plan
• Competitive wages
• Stability and career advancement
• Continuing Education Opportunities

CATEGORIES OF DUTIES

• Audit all records and provide ICD-9-CM Coding for all diagnoses.
• Attention to detail and ability to work under stressful circumstances.
• Enter patient admission and discharge information accurately into the master patient index when necessary. Audit this information when necessary and assure quality and consistency in its completeness.
• Enters patient admission and discharge information onto the OSHPD abstract electronically and use ICD-9CM for coding of psychological and medical diagnosis'-Central Site Only.
• Answer and respond to all medical records requests, subpoenas and court orders for appropriate facility, in accordance with federal, state and HIPAA guidelines.
• Retrieves records for auditing purposes.
• Analyzes all discharged patient records in accordance with JCAHO standards, federal and state regulations, facility and contract requirements.
• Files dictated and loose reports into the discharged patient records. Supports and assists in the processes of purging and offsite storage as needed.
• Maintain medical record statistical reports.
• Responsible to maintain assigned Terminal Digit order of all discharged medical records on and off site.
• Maintain custody and security of the discharged medical record at all times.
• Completes studies and special projects as requested.
• Attends appropriate meetings, activities, and workshops to improve and maintain knowledge of the department, hospital, and agency responsibilities.
• Assists the HIM Consultant and the HIM Supervisor in the development and review and revision of departmental policies and procedures.
• Assist the site/program director as needed with HIM related functions.
• Responsible for Terminal Digit split assignment.
• Follows Staff of The Day and Phone Coverage Schedules.
• Maintains patient confidentiality.
• Carries out any other requests as set forth by Administration or immediate supervisor.

PHYSICAL REQUIREMENTS

Bending, sitting, lifting up to 10 pounds. Repetitive motions for typing, reading information on computer monitor and graphs.

EDUCATION/TRAINING/EXPERIENCE

High School Diploma or equivalent

Five (5) years Medical Records experience in an acute care or behavioral health setting preferred. Five (5) years of ICD-9-CM Coding experience preferred.

In depth knowledge of Medical Terminology and Anatomy desired.

LICENSES/CERTIFICATES

None

SETTING

Tarzana Treatment Centers, Inc. is a non-profit corporation, which provides behavioral healthcare services, including chemical dependency.

EQUAL OPPORTUNITY EMPLOYER

Tarzana Treatment Centers, Inc. does not discriminate as to race, nationality, religion, gender, sexual orientation and disability in its hiring practices.

ADA REQUIREMENT

Tarzana Treatment Centers, Inc. supports the Americans with Disabilities Act. Discrimination is prohibited in all aspects of employment against disabled persons, who, with reasonable accommodations, can perform the essential functions of a job.