Medical Records Clerk

1 week ago


Artesia, New Mexico, United States Artesia General Hospital Full time

Job Summary: Performs the services of copying, chart assembly, analysis, and chart retrieval of patient medical records.

ESSENTIAL FUNCTIONS:

  • Receive and process patient records following discharge.
  • In an expedient, efficient manner, goes to the various units, picks up the prior day's discharges, and deposits the records in the coding area.
  • Via computer reports, validates each record into the MRD post discharge: locates and secures any missing paperwork.
  • Ensures all prior day discharges have been received and retrieves any missing paperwork.
  • Accurate assembly/analysis (A&A) of records following discharge.
  • Accurately analyzes the incomplete record to ensure compliance with regulatory standards and Medical Staff Bylaws, Rules & Regulations.
  • Consistently meets performance expectations for A&A.
  • Adding/resolving deficiencies within the computer system accurately.
  • Tracks charts out of the department as requested using the computer system checking the chart out to the proper location and individual; requires signature page.
  • Vital Statistics.
  • Incomplete record process.
  • Record retention/storage.
  • Maintenance of the Master Patient Index.
  • Charting transcribed reports twice daily to completion (includes routing copies as required).
  • Meets established deadlines.
  • Preps and scans records into electronic health record in a timely, efficient, accurate manner in order to facilitate timely coding.
  • Participates in Performance Improvement and Quality Control Activities by data gathering, validation of data, and/or preparing accurate reports in a timely fashion, meeting deadlines.
  • Consistently demonstrates behavior that reflects working as a team is more important than self-interest.
  • Displays initiative to see processes through to completion and offers assistance without being asked.
  • Responds to request in a timely manner.
  • Demonstrates courteous and positive behaviors (i.e. smile, pleasant tone, good eye contact).
  • Assist with other clerical duties within the department as assigned by Supervisor.
  • Calculate/resolve chart deficiencies.
  • Maintain chart location system.
  • Assist physicians with incomplete record process.
  • Maintain Master Patient Index.
  • Prep and scan records into electronic health record.
  • Maintain accurate record retention and storage.
ADDITIONAL RESPONSIBILITIES:
  • Performs other duties as assigned
KNOWLEDGE/SKILL/ABILITIES:
  • Basic computer knowledge
  • Able to handle interruptions.
AGE-RELATED COMPETENCIES: Demonstrates the basic knowledge and skills necessary to identify age-specific patient needs appropriate for this position.

Information Management: Treats all information and data within the scope of the position with appropriate confidentiality and security.

Risk Management/Quality Management/Safety: Cooperates fully in all Risk Management, Quality Management, and Safety Activities and Investigations.

MINIMUM POSITION QUALIFICATIONS:
  • Education - High school diploma or equivalent.
  • Work Experience - Basic office skills, with good customer service; prior medical record experience preferred.
  • Training
  • License/Certification

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