Medical Records Administrator Specialist

<p>This position is located in the Health Information Management Section of Health Administration Service at the Fayetteville NC VA Coastal Health Care System. Medical Records Administration Specialist (MRAS) in Veterans Health Administration perform work concerned with the management of a health record program or the provision of services related to medical record administration/health information services. Manage, preserve, analyze, & supervise the use of diagnostic & therapeutic health.</p><h3>Major Duties</h3><p>Assists the Chief, Health Information Management (CHIM) and the HIM Department in identifying and setting short and long-range goals, program objectives, and tasks to meet the mission and vision of the VAMC. Provides subject matter expertise to Service Line Leaders, and medical center staff. Interprets and applies The Joint Commission (TJC) standards, VHA regulations and medico-legal requirements; current federal codes pertinent to health records; VHA policy memoranda, directives, handbooks and program guides pertinent to health information management; medical coding (ICD, CPT, HCPCS) and reimbursement methodologies; medical and procedural terminology; anatomy and physiology; regulations governing confidentiality of health records; release of information laws and statutes; and all policies/procedures pertaining to VHA health records. Provides training for HIM, clinical and administrative staff on HIM topics. Designs and performs quality improvement projects regarding HIM issues. Assists the CHIM in preparing and conducting various presentations. Keeps current on emerging issues and trends in the HIM field, including process improvement initiatives, the electronic health record (EHR), coding and computer-assisted coding, the revenue cycle, release of information and privacy issues, records management, medical speech recognition, transcription and data entry, and health information exchange. Performs audits and analyses, preparing and presenting findings and recommendations to the CHIM, Service Line Leaders and medical staff. Assures the accuracy and timeliness of the capturing of patient services charges (workload) in accordance with all applicable laws and regulations. Reviews, analyzes and reports HIM performance monitors. Advises Principal Investigators and other clinical staff on methodologies related to retrieval of health care data for specific studies. Performs data retrieval for special studies as needed. Utilizes advanced knowledge of VHA data sources, such as VHA Support Service Center (VSSC) and the Corporate Data Warehouse (CDW), to complete analyses of VA Medical Center data. Analyzes and evaluates on a quantitative basis, the effectiveness of the HIM program and operations in meeting established goals and objectives. Analyzes program performance data to identify areas needing improvement. Reviews and tests HIM related software patches; test and troubleshooting EHR menu options and functional issues when HIM users report application errors; perform equipment needs analysis for new or replacement equipment and/or equipment repair; submit work orders or Remedy tickets for correction to HIM software errors. Serves as point of contact for health record corrections to ensure documentation accurately reflects care delivered and reported. Documentation corrections may consist of retracting erroneous notes, re-titling notes, assigning notes to or removing from consult requests. Collaborates on improperly identified documents with clinicians, Clinical Applications Coordinators (CACs) and others who report problems. Reassigns, rescinds, and removes documents when they have been entered or uploaded incorrectly. Provides education when dealing directly with physicians, nurses and other clinical providers requesting completion or adjustment of pertinent parts of the health records, which are found to be inconsistent or incomplete upon analysis. Assists and provides guidance to supporting clinical services to capture required medical information on patients for computer database input. Selects, compiles and trends medical, surgical, and statistical data from numerous components of the health record. Retrieves diagnostic and statistical data for various reports required locally or by VISN or VHA Central Office. May assign User Classes to users at the request of the Chief HIM; responds to questions or issues related to that user class. Reviews requests for new templates or additions/correction to existing templates (e.g., clinical reminder dialogs, documentation templates, PowerForms). Reviews requests for new paper forms and assists in the creation and implementation of electronic versions of these forms so that they are always available to EHR users. Work Schedule: Monday - Friday, 8:00am - 4:30pm Telework: Not authorized Functional Statement #: 000000 Relocation/Recruitment Incentives: Not authorized. Permanent Change of Station (PCS): Not authorized.</p><h3>Requirements</h3>You must be a U.S. Citizen to apply for this job. To be considered for this position, you must complete all required steps in the process. In addition to the application and questionnaire, this position requires an online assessment. The online assessment measures critical general competencies required to perform the job. All applicants tentatively selected for VA employment in a testing designated position are subject to urinalysis to screen for illegal drug use prior to appointment. Applicants who refuse to be tested will be denied employment with VA. Selective Service Registration is required for males born after 12/31/1959. Must be proficient in written and spoken English. Subject to background/security investigation. Selected applicants will be required to complete an online onboarding process. Acceptable form(s) of identification will be required to complete pre-employment requirements (https://www.uscis.gov/i-9-central/form-i-9-acceptable-documents). Effective May 7, 2025, driver's licenses or state-issued identification cards that are not REAL ID compliant cannot be utilized as an acceptable form of identification for employment. Must pass pre-employment physical examination. Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP). Complete all application requirements detailed in the "Required Documents" section of this announcement. As a condition of employment for accepting this position, you will be required to serve a 1 or 2-year trial period during which we will evaluate your fitness and whether your continued employment advances the public interest. In determining if your employment advances the public interest, we may consider: your performance and conduct; the needs and interests of the agency; whether your continued employment would advance organizational goals of the agency or the Government; and whether your continued employment would advance the efficiency of the Federal service. Upon completion of your trial period, your employment will be terminated unless you receive certification, in writing, that your continued employment advances the public interest.<h3>Education</h3>Note: Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment. You can verify your education here: http://ope.ed.gov/accreditation/. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. For further information, visit: https://sites.ed.gov/international/recognition-of-foreign-qualifications/.