The HIM Technician III analyzes records and maintains clinician incomplete records. Performs general administrative duties as directed that may include but is not limited to Quality Control (QC) of the scanned documents, assisting with transcription processing, assisting with Master Patient Index (MPI) maintenance, assisting with coding workflow processing, release of information (ROI), filing, data entry, answering phone calls, and assisting visitors and physicians. A minimum of 95% accuracy is expected for all tasks.
Master all job accountabilities outlined in HIM Technician II
Compiles statistical data, such as admissions, discharges, deaths, births, and types of treatment given.
Abstracts information for the medical record.
Analyzes records in accordance with the HIM analysis procedure with a minimum of 95% accuracy.
Performs quantity and quality checks on scanned medical record information as part of Quality Control (QC) function.
Ensure all scanned documents are scanned in chronological order
Ensure patient identifiers are present on all scanned pages
Ensure that all scanned documents belong to the same patient with the same date of service
Verify that images are correct and legible. Review each electronic image and compare with the hard copy to confirm the image quality, appropriate order and appropriate rotation.
Conducts quality assurance and quality improvement on scanned/indexed documents
Enters, edits and tracks medical record deficiencies in chart management system. Effectively communicates with physicians to resolve and manage physician deficiencies.
Reviews medical records edited by physicians and updates the HIM system as needed.
Compiles, updates, and reports physician record completion statistics and physician notification letters. Prepares physician list and handles the suspension process.
Produces and distributes delinquency notification/suspension letters, verifies accuracy of deficiency information, reports physician record completion statistics and updates.
Monitors records submitted for reanalysis to ensure accurate completion of records. Ensures completion of existing file deficiencies and verifies accuracy of information submitted
Serves as a liaison to physicians regarding issues related to incomplete records and documentation to ensure adherence to Joint Commission standards and compliance requirements.
Facilitates chart availability and readiness for coding.
Assures patient's records have been received upon patient discharge.
Assists visitors and physicians, and answers phone as needed.
Monitors the transcription system if needed.
Coordinates the ROI function if needed.
Responsible for the integrity and quality of the documents that are scanned into the document management system, tracking of unidentified documents, re-scanning documents, assigning document types to unknown documents.
Ensures that all discharged records are received from the units for document imaging. Performs follow up of missing documents and verification that all charts have been received and scanned.
Continuously meets all turnaround times as requested.
Responsible for analysis of patient's records for needed documentation by the physician as well as for the physician suspension process and record deficiency tracking.
Operates computer to enter and retrieve data.
Accepts subpoenas after verifying there validity.
Responsible for accurately scanning authorizations, subpoenas, request into the system.
Ensures all documentation is accurate and in the appropriate format to meet Joint Commission accreditation standards.
Reviews the integrity of the Master Patient Index (MPI) to provide an accurate database, ensure each patient and number is uniquely and correctly identified.
Combines patient records that are duplicated; pull and combine chart to merge the physical record.
Handles all incoming calls regarding registration issues due to duplicate or incorrect number assignment.
Maintains log of activities. Continuously meets all turnaround times as requested.
Meets or exceeds productivity standards.
Responsible for cross training peers.
Assists the HIM Department and various work units during times of staff shortage or high volumes
Maintains strict physician and patient confidentiality
Follows all federal, state, industry, and hospital guidelines for release of information.
Reviews materials, complete all required client/nThrive policy training documents and passes required tests.
Supports nThrives's Compliance Program by demonstrating adherence to all relevant compliance policies and procedures as evidenced by in-service attendance and daily practice; notifying management when there is a compliance concern or incident; demonstrating knowledge of HIPAA Privacy and Security Regulations as evidenced by appropriate handling of patient information; promoting confidentiality and using discretion when handling patient information.
High school graduate or GED.
Minimum two years of previous HIM or equivalent experience or education required and demonstrated successful completion of job accountabilities of Tech II for six months.
Proficiency with hospital HIM computer systems.
Knowledge of medical terminology.
Strong computer knowledge including MS Office (Outlook, Word, Excel).
Be Inspired. Ignite Change. Transform Health Care.
From Patient-to-PaymentSM, nThrive provides all the technology, advisory expertise, services, analytics and education programs health care organizations need to thrive in the communities they serve. Our colleagues share a united passion to help health care organizations strengthen their financial position, which translates to accessible, quality care for all. This passion fuels our drive to innovate and participate in community outreach through the nThrive CARES program. Our colleagues are encouraged to think differently and empowered to make a lasting impact that ensures our health care providers, and our world, are healthy and productive.