Description:
Status Hours:
16 hrs/wk
Job Summary: Activities include but are not limited to: maintaining medical record integrity through filing, assembling, retrieving patient records, process requests for patient records timely and in compliance with state and federal, and maintaining the patient master index. Also assists Physicians and hospital staff in locating medical records. Responsible for charge entry as assigned.
Essential Duties:
1. Complete the OPD unit record procedure to include ER, WI Clinic, and Specialty Clinic.
2. Retrieve medical records, process requests for patient records timely and in compliance with state and federal regulations, sign out as outlined in a timely manner, and deliver charts to ED if nursing cannot pick up.
3. File all medical records in appropriate area within Health Info Management.
4. File all inpatient late reports as they appear in department.
5. File living wills/advanced directives as outlined in a timely manner.
6. File all ancillary reports in a timely manner.
7. Complete final review procedure on inpatient and ODS medical records.
8. Enter, batch total, and post charges in a timely fashion.
Other Responsibilities:
1. Complete work within designated time.
2. Attend workshops and in-services when made available.
3. Perform in an independent manner with some supervision.
4. Display courtesy at all times when communicating with Physicians and staff members.
5. Perform backup for Discharge Analyst when needed.
6. Process ROI requests in a timely manner.
7. Perform related duties as assigned, or as the situation dictates.
8. Demonstrate the ability to work independently and maintain accountability for own actions.
9. Show initiative and follow-through.
10. Demonstrate productivity at work (makes good use of down time).
11. Perform duties willingly and enthusiastically.
12. Return to work from breaks, meals, meetings, and in-services in a timely fashion.
13. Take appropriate actions when safety issues are identified (report hazardous situations to appropriate person, remove malfunctioning equipment, etc.)
14. Follow recommendations designed to reduce worksite injuries (proper body mechanics, personal protective gear, safe sharps, etc.).
15. Demonstrate the ability to be flexible, organized, and function under stressful situations.
16. Demonstrate judicious use of supplies.
17. Complies with local, state, and federal laws and regulations.
Requirements:
Education, Skills, Experience Requirements:
1. Completion of any in-hospital training required.
2. Ability to relate professionally with other hospital staff.
3. Ability to organize and prioritize work.
4. High School Diploma or GED/equivalent business training.
5. Knowledge of medical terminology preferred; office procedures; typing.
Physical Demand Requirements:
1. Sitting: less than 1 hour per day.
2. Standing or walking: 4-7 hours/day.
3. Wrist deviation: moderate to extensive.
4. Lifting: 10-25 pounds with good body mechanics.
5. Squatting/kneeling: 1-3 hours per day.
6. Needs to climb: 4-10 occasions per day.
7. Endurance: moderate energy requirements.
8. Pinching: Frequent; 500-1000 or greater pinches per day.
9. Manual dexterity: frequent fine motor skills required.
10. Both handedness: 70-100% of job cycle time.
11. Requires very acute near vision (20/20), and minimal depth perception required.
12. Visual color discrimination: requires both red/green and blue/violet discrimination.
13. Requires hearing whispered voice at 20 feet with minimal speaking ability required.
Organizational requirements:
1. Reports to work on time and as scheduled.
2. Wears identification while on duty.
3. Uses computerized punch time system correctly.
4. Adheres to Appearance and Dress Code policy, appearance is neat and tidy:
a) Fingernails must be clean, neatly manicured and of reasonable length. Artificial nails may not be worn in identified areas per Infection Control Policy.
b) Makeup and jewelry should be worn in a conservative and tasteful manner. Jewelry should not present a safety hazard or interfere with job performance.
5. Maintains and ensures patient confidentiality at all times.
6. Complies with all organizational policies regarding ethical business practices.
7. Adheres to safety policies as evidenced by in-service attendance records and employee practices.
8. Maintains regulatory requirements (i.e licensing, certification).
9. Attends staff meetings, reviews monthly staff meeting minutes of missed meetings.
10. Parks in designated employee areas.
11. Does not exceed 3% unscheduled absences.
Promote a Collaborative and Cooperative Environment:
1. Establish good rapport and cooperative working relationships with other members of the organization to promote quality care and service.
2. Handle conflict appropriately (use “I” statements to discuss issues, discuss privately and directly with the individual involved, obtain assistance from supervisor when needed).
3. Respond appropriately to change (remain open-minded, keeps personal agendas out).
4. Represent the organization in a positive and professional manner (language and actions reflect the mission and vision of CMC).
5. Participate in performance improvement by identifying problems and potential solutions (Be Part of the Solution, Not Part of the Problem).
6. Treat patients, family visitors and co-workers with respect and dignity (address individuals courteously, knock before entering, keep voice down, and display positive regard).
7. Provide exceptional customer service, thus contributing to the “WOW” experience (offer assistance before being asked, go one step extra to help, smile and make eye contact when speaking).
Cognitive Environment Requirements:
1. Some problem solving required, as well as making independent judgments and decisions.
2. Continuously assess situations and determine corrective actions as needed.
Emotional Environment Requirements:
1. Must remain calm & exercise self-control in working relationships.
