Job Posting
Director of H.I.M. Privacy Officer / Medical Staff Coordinator - Health Information Management
JOB RELATIONSHIPS:
Responsible to:
Administrator/CEO.
Responsible for:
Employees of the Health Information Management department.
Interrelationships:
Must demonstrate the ability to establish and maintain effective working relationships with medical staff and co-workers. Must be able to maintain confidentiality.
JOB SUMMARY:
Plans, organizes, and directs the provision of medical record services; establishes policies, procedures, standards, and departmental objectives; supervises all functions, including transcription, record completion, transmission, indexing, abstracting, coding, research, filing, storage, tumor registry, trauma registry, retrieval, and maintenance.
Serving as the Hospital�s Privacy Officer. Oversees all ongoing activities related to the development, implementation, maintenance of, and adherence to the organization�s policies and procedures covering the privacy of and access to patient health information in compliance with federal and state laws and Greenwood County Hospital�s information privacy practices.
Serving as the medical staff coordinator, reports to the Administrator and serves as liaison between the medical staff and the QI/RM director. Coordinates medical staff activities and informs the administrator of problems and issues related to the medical staff. Responsibilities include coordination of hospital medical staff credentialing, reappointment, and quality improvement/risk management processes. May request reports and information from other hospital departments or agencies related to medical staff functions and in accordance with established programs.
JOB QUALIFICATIONS:
Experience:
Minimum of three years experience in medical record administration.
Individual who is highly motivated and self-directed.
Capable of gathering data and making sound, mature decisions.
Highly developed written and verbal skills.
Working knowledge of ICD-9-CM, CPT 4, and encoding systems.
Education:
Associates degree or baccalaureate degree in HIM or related field, AHIMA member in good standing.
Training in word processing, spreadsheet, and database management skills.
Req. Certification/Registration:
RHIT or RHIA credentials. Coding Certification helpful but not required.
Essential Functions:
Standing, walking, bending, stooping, and climbing 40%; sitting 60% of time.
Eye-hand coordination.
Occasionally lifts supplies and equipment with weights of up to 15 pounds above shoulder level.
Typical Working Conditions:
Works in a clean, moderately lighted office environment with close
quarters.
Requires ability to concentrate for long periods of time while dealing with distractions.
Occasionally subjected to long and irregular hours. Must be able to cope with the pressure of requested demands.
JOB DUTIES:
1.Analyzes and plans for the adequacy of the Medical Records filing system in order to maintain appropriate capacity for proposed storage requirements based on expected future growth; recommends a cost-effective imaging/scanning plan and/or remote storage facilities as appropriate.
2.Effectively assists in the planning, development, and revision of policies and procedures related to Health Information, the medical staff, utilization review, and quality assurance.
3.Effectively plans and coordinates the preparation for onsite reviews by third-party payers, PRO, outside review organizations, and Blue Cross.
4.Establishes and submits to administration departmental goals and objectives based on the overall goals of the institution.
5.Promotes good staffing practices by maximizing the utilization of human resources; forecasts and anticipates the personnel needs of the Health Information Department with regard to fluctuations in the patient workload; holds staffing at a functional minimum; effectively employs part-time help.
6.Demonstrates effectiveness in preparing an annual departmental budget addressing capital equipment, personnel, inventories, supplies, and other departmental costs. The budget is submitted for approval by the required time. Ensures that department operates within budget.
7.Establishes and enforces coding guidelines; perform coding audits on a quarterly basis to ensure compliance; implements corrective action as necessary.
8.Establishes and enforces transcription guidelines; perform transcription audits on a quarterly basis to ensure compliance; implements corrective action as necessary.
9.Regularly measures individual employee performance against established performance standards; utilizes evaluations as an objective management tool for counseling staff members to higher levels of performance; completes the performance evaluation on/by the due date.
10.Ensures that sufficient cross training is provided for members of the department to increase departmental efficiency and promote employee development.
11.Participates in space utilization/consolidation studies and analysis; develops recommended plans to maximize operational efficiency and Medical Records effectiveness; ensures that the Medical Records facilities are easily accessible to the medical staff
12.As required, effectively plans the schedules for students in academic programs, for Health Information technicians, or for Health Information administrators to ensure maximal departmental efficiency
13.Consistently maintains a proper balance and allows appropriate time for administrative responsibilities, inservices, staff meetings, and other professional activities; organizes time well.
14.Ensures that all employees of the HIM department understand their personal role in the event of a fire or internal/external disaster while on duty; regularly reviews departmental fire and disaster procedures.
15.Ensures that policy and procedure manuals are current and are reviewed regularly by all staff members; reviews and revises policies and procedures on an annual basis or as necessary.
16.Consistently meets state regulatory agencies as outlined in the respective manuals; complies with contingencies and deficiencies so that they are corrected by the required date.
17.Consistently combines ethical judgment with technical skills within the policy and legal
guidelines of the institution; understands the legal, social, economic, and political forces which influence the health care system.
18.Effectively interfaces with a variety of regulatory agencies in order to provide them with required statistical and procedural information in order to ensure that the HIM department is in compliance with their rules, regulations, and guidelines.
19.Develops implements and monitors the Medical Records Quality Assurance Program in order to evaluate the quality of the work performed through internal audits in areas such as coding, analysis, transcription, filing, statistics, etc; ensures that identified problems are resolved.
20.Develops, implements, and monitors verification checks for accuracy, consistency, and uniformity of data recorded and coded for indexes and statistical record systems and for use in quality assessment activities as a regular part of the medical record abstracting process.
21.Ensures that criteria-based performance evaluation standards have been developed for each position in the HIM department; revises performance standards as necessary.
22.Ensures that all records requested by review and regulatory agencies are either copied or made available for review (whichever applies) by the specified deadlines.
23.Ensures that all records requested by patients, lawyers, subpoenas, workers compensation, physicians, and hospitals are released according to departmental and regulatory guidelines.
24.Maintains appropriate controls to ensure that all medial records are confidential, secure, current, authenticated, legible, and complete.
25.Consistently ensures that all DRG denials and pending denials are responded to within the specified time frames.
26.Ensures that strict confidentiality guidelines are adhered to by all staff members, both intra- and interdepartmentally; takes immediate disciplinary actions with regard to any confidentiality violations.
27.Regularly encourages feedback from physicians and other hospital staff members regarding perception of case-mix and DRG assignment; utilizes feedback to improve the quality of information gathered.
28.Regularly maintains active and supportive communication with physicians, administrator, and others concerning progress, problems, or other issues related to the DRG process and/or other HIM functions.
29.Responsible for determining the need for back-up transcription in order to ensure timeliness in transcription.
30.Ensures that institutional policies and procedures for maintenance of medical records are followed.
31.Participates in and coordinates committee functions related to medical records/health information systems.
32.Creates and directs procedures to assure proper completion and flow of records and reports.
33.Ensures availability of medical records for various committee reviews.
34.Responsible for determining cases which can be sent to MRC for appeals and sending appropriate records; following up with the Business Office on appeal decisions.
35.Consistently relates well to staff and immediately resolves staff's problems, concerns, and grievances.
36.Maintains a safe, fair, and impartial approach to dealing with employees.
37.Motivates employees through use of positive reinforcement and recognition of employee problems with efforts to resolve these problems.
38.Conducts departmental meetings to maintain two-way communication, problem solving, and information passing a minimum of once a month.
39.Oversees daily activities of the department to optimize productivity.
40.Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of the latest trends in the field.
41.Delegates authority as needed.
42.Uses accurate, clear, and concise oral and written communication.
43.Plans and offers various inservice educational materials and instruction for employees.
44.Observe for medical staff issues of potential concern and initiate action to resolve and document action and resolution in a timely manner.
45.Effectively assist in the planning, development, and revision of policies and/or programs related to medical staff Quality Assurance.
46.Maintain medical library and/or reference books for medical staff which are up to date and which reflect current trends in the practices of medicine, surgery, obstetrics, and pediatrics.
47.Assist in conducting a formal program of orientation to the hospital and staff for new physicians. This includes educating them on medical staff required functions, peer review, risk management, quality improvement and utilization management.
48.Maintain and conduct a data gathering process for hospital usage statistics and distribute the resulting information appropriately and timely.
49.Obtain physician signatures on PRO penalty statements without error or omission.
50.Send reference letters on new applicants to Medical Staff to verify application.
51.Administer programs and systems of tracking as related to reappointment, medical staff variances, peer review and quality monitoring.
52.Prepare and facilitate all medical staff department meetings. This includes timely notification, preparation of meeting materials, transcription and distribution of materials.
53.Ensure that bylaws are current and reviewed regularly by all medical staff.
54.Query the National Practitioner Data Bank on physicians meeting the required guidelines.
55.Consistently combine ethical judgment with technical skills within the policy and legal
guidelines of the institution.
56.Keep abreast of regulatory agency requirements pertaining to medical staff affairs.
57.Be available to medical and hospital staff in addressing questions or concerns regarding the medical staff.
58.Submit required reports and information to health care regulatory boards and review agencies prior to established deadlines.
59.Request responses from Medical Staff to send to PRO concerning potential admission denials, potential DRG revisions, and quality concerns.
60.Develop and maintain physician database by entering new or updated information on a monthly basis.
61.Prepares Mortality Report on monthly basis for Medical Executive Committee.
62.Codes inpatient charts in a timely fashion within 30 days of discharge.
63.Sequences all possible diagnoses and procedures on the medical record face sheet with a 95% accuracy rate.
64.Always maintain a 95% level of accuracy in coding of diagnoses and procedures.
65.Demonstrates a thorough working knowledge of ICD-9-CM, CPT 4, coding systems, and DRGs.
66.Demonstrates the ability to read, write, and comprehend the contents of a medical chart sufficiently to code hospital discharge records.
67.Take on the responsibility of ensuring that all potential DRG changes by the PRO are carefully scrutinized and followed-up.
68.Submits a copy of the Case Summary sheet to attending physician and/or consulting physician.
69.Assists in coding outpatient records as needed.
70.After chart is coded, analyzes chart for deficiencies and routes to physician for completion.
71.Screens and abstracts selected Blue Cross inpatient charts with Severity and Intensity (S&I) criteria with a 95% accuracy rate.
72.Updates coding procedures and guidelines and ensures that updates are provided to all backup coders.
73.May act as a liaison with physicians and outside agencies on code assignments.
74.Inputs all code numbers into the abstracting system for billing with 96% accuracy.
75.Abstracts from patient chart designated information including such items as patient's name, sex, age, admission and discharge date, status upon discharge, medical record number, patient account number, attending physician and surgeon, and any other required demographic information.
76.Maintains a control log listing records to be abstracted.
77.Performs monthly transmittals to KHDS when charts are completed.
78.Reviews reports from KHDS for accuracy; sends corrections to KHDS as warranted.
79.Performs QA review on abstracts on a quarterly basis.
80.Identifies the hospital's case mix and monitors changes in case mix patterns.
81.Serves as primary resource person for the dissemination of information regarding DRG's including proposed changes in regulations and anticipated institutional impact of these changes.
82.Assist in transcription as needed with no more than 2 errors per report.
83.Assures correct spelling of medical terms and other words; always utilizes accurate punctuation and grammar.
84.Demonstrates a thorough working knowledge of medical terminology; asks questions to clarify misunderstandings.
85.Verifies and accurately transcribes patient identification, medical record number, and physician identification on all reports.
86.Accurately chart transcribed reports without error.
87.Dispatches finished reports to designated person(s) for approval and signature.
88.Assembles and maintain records in proper order per departmental policy.
89.Analyzes inpatient chart screening for missing dictation, signatures, and departmental reports.
90.Screens both inpatient and outpatient charts with correct Medical Staff peer review criteria.
91.Files all loose reports on correct chart without error.
92.Develop, implement, and monitor physician deficiencies in the chart locator system.
93.Logs and routes charts through the department utilizing the chart locator system.
94.Safeguards and preserves the confidentiality of records in accordance with hospital and departmental policy.
95.Develops and implements procedures to respond to subpoenas and insurance company requirements for information to ensure that released information meets legal requirements.
96.Assists in releasing patient information as needed per departmental policy.
97.Handle telephone information requests with courtesy, accuracy, and respect for patient confidentiality; receive information and distribute messages as necessary.
98.Assists in faxing medical information on an emergency basis as requested.
99.Identifies cases of malignant diseases, which need to be copied and sent to Kansas Cancer Registry.
100.Preserves the confidentiality and security of patient data stored in the tumor registry files.
101.Assembles and disseminates tumor registry data.
102.Completes follow-up forms on cases identified by Kansas Cancer Registry.
103.Responsible for administering all patient rights and privacy practices under the privacy regulations
104.Logs all complaints 9patient initiated complaints, risk management complaints, and other complaints related to the privacy of health information and, when necessary be responsible for all investigations related to the uses and disclosures of health information and patient rights.
105.Reports the results of investigations to the privacy Oversight Committee for further action if necessary.
106.Responsible for all documentation and retention of all documents related to the privacy
of health Information. All documents shall be maintained for ten years from the date of the document.
107.Reports all results of compliance monitoring to the Administrator/CEO.
108.Completes monthly statistical report for acute, Swingbed, and intermediate patients and submits information to Business Office by the 5th of the month.
109.Prepares periodic reports for administration as requested.
110.Submits chart deficiency listing to administration and physicians on a weekly basis.
111.Completes birth certificate registrations and reports findings to state regulatory agency.
112.Report burn cases to Kansas State Fire Marshall per state regulations.
113.Participates in hospital committee meetings as required. Attends and serves on professional/civic service organizations as hospital representative.
114.Completes an outguide and/or electronically logs records out of the department.
Additional Information
Position Type : Full Time
Contact Information
Janel Palmer - HR Director
Human Resources
100 16th St
Eureka, KS 67045
Email: jpalmer@gwch.org
Phone: 620.583.7451
Fax: 620.583.6702
Director of H.I.M. Privacy Officer / Medical Staff Coordinator Health Information Management |
