HIM Operations Specialist I

Major Responsibilities:

Accurately upload/Index outside records using applicable software, routing documentation to the clinician as appropriate. Creates or selects the appropriate patient, encounter, and/or order while assigning the correct document type and description when indexing into the EHR.

Incorporates internal and external clinical documentation from various electronic and paper sources via applicable software work queues, rounding, eDelivery or importing into the EHR according to HIM procedures while meeting established benchmarks for quality, accuracy, and productivity. Applies knowledge of medical terminology and nomenclature to accurately identify documentation needs based on patient service areas and level of service provided.

Analyzes the content of the medical record for missing documentation and signatures and assign/edit medical record deficiencies by the responsible provider into the chart management system according to State and Federal regulations, such as Det Norski Veritas (DNV) or The Joint Commission (TJC), Centers for Medicare and Medicaid (CMS), all Medical Staff Bylaws and organizational policies. Provides support and education to clinicians regarding record completion activities.

Applies knowledge of medical terminology and nomenclature to accurately identify documentation needs based on patient service areas and level of service provided.

Collaborates with Data integrity or other functional areas to ensure errors in documentation discovered are communicated for Chart Correction. Notifies appropriate leadership for quality review and privacy investigation.

Ensures clarity, legibility, and position of the scanned documents are readable by the end-user or indicates best quality.

Serves as point of contact for record completion support for clinicians and other providers.

Licensure, Registration, and/or Certification Required:

None Required.

Education Required:

High School Graduate or Equivalent

Experience Required:

Typically requires 0-1 years of experience in healthcare.

Knowledge, Skills & Abilities Required:

Proficient computer and keyboarding skills with the ability to learn new computer software systems such as Epic, OnBase, Solarity, Microsoft Office, and legacy archives, and electronic communication and meeting platforms such as Teams.

High attention to detail and accuracy with frequent interruptions.

Ability to prioritize workload and work under pressure in a fast-paced environment with time constraints.

Ability to work independently and make decisions with minimal supervision while maintaining quality and productivity standards.

Works collaboratively in a diverse team environment with openness and respect to learn, create and problem solve.

Ability to adapt to a fast-paced environment and transition to switching tasks without issue while maintaining quality and accuracy.

Ability to learn when receiving constructive feedback by leadership or peers and taking personal ownership for success.

Strong interpersonal and communication skills.

Ability to safeguard protected health information (PHI) and basic knowledge of HIPAA.

P hysical Requirements and Working Conditions:

Operates all equipment necessary to perform the job.

Exposed to a normal office environment.

Sits most of the workday.

Ability to perform repetitive functions and hand movements in a normal office environment

DISCLAIMER

All responsibilities and requirements are subject to possible modification to reasonably accommodate individuals with disabilities.

This job description in no way states or implies that these are the only responsibilities to be performed by an employee occupying this job or position. Employees must follow any other job-related instructions and perform any other job-related duties requested by their leaders.