Medical records administrator (assistant chief health information managementt)

Summary

This position is located in the Health Information Management (HIM) Section of the Health Administration Service of the Central Alabama Veterans' Health Care System. Medical Records Administrators (MRAs) in VHA perform or supervise work concerned with the management of a health record program or the provision of services related to medical record administration/health information services.

Duties

Assists the Chief HIM (CHIM) in establishing policies, responsibilities, and requirements for health information management (HIM) related matters, such as health record documentation, coding and clinical documentation improvement, records management, release of information, file room/scanning, transcription and medical speech recognition, as well as the overall management of health information and Veteran's health records. Oversee implementation and adherence to HIM industry standards, policies, procedures, laws, regulations, and accrediting bodies. Ensures the facility is in compliance with applicable standards by completing HIM audits, healthcare data reports, and statistical information, for timely and accurate reporting. Establish, implement, and monitor HIM performance through metrics, productivity measures, benchmarking, and other applicable tools. Provides consultation and management support to the above units to ensure smooth operation of a customer-focused, forward-thinking and efficiently managed department. Functions as Acting Chief of the Section and is responsible for overall management of the Sections' program and function. Aids with the overall effective administration and planning of the HIM program throughout all areas of the facility in order to give maximum support to the staff in the treatment of patients.

Performs documentation corrections: documentation errors consist of retracting erroneous notes, re-titling notes, assigning notes to or removing from consult requests. Analyzes workflow to determine potential problem areas and makes recommendations to correct these areas and improve coordination between the various units. Obtains, organizes, files, and retrieves reports, correspondence, and financial data for use in preparing status reports, briefings, and presentations. Identifies and recommends ways of eliminating, combining, simplifying, or improving procedures and processes. Establishes criteria and provides education when dealing directly with physicians, nurses and other clinical providers requesting them to complete or adjust pertinent parts of the health records, which are found to be inconsistent or incomplete upon analysis. 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 Central Office. Prepares training materials and participates in orientation and instructional activities as required. Advises management and hospital staff members on policies, procedures and adequacy of record content, and on training and teaching of clerical personnel in health record functions. Participates in various health record review activities. Assists the CHIM in identifying and setting short- and long-range goals, program objectives and tasks to meet the mission and vision of the medical center. Assists with planning, developing, directing and evaluating health information and other functions. Demonstrates skill in budgeting, contracting, procurement and property management. Designs and implements a program to measure compliance with documentation standards for all areas of the medical center including: inpatient, outpatient, home health, long term care, behavioral health, rehabilitation and fee basis. Aids in a variety of projects and is responsible for screening, abstracting and tallying data from records and computer-generated reports. Serve as a consultant to provide guidance and advise researchers on methods for gathering data. Assists in selected miscellaneous retrospective medical record review/data abstraction projects to support medical center Quality Management data collection activities. Advises staff in problem areas about quantitative and qualitative analysis of health records and determines acceptability of content. Consults with physicians and other clinicians regarding health record deficiencies as appropriate. Assists with the retrieval, review, analysis and reporting of HIM performance monitors and other medical record review topics.

Work Schedule

Monday - Friday 8:00a.m. - 4:30p.m. Work schedule subject to change based on agency needs.

Telework

This is not a virtual position.

Functional Statement #

619-55278F

Relocation/Recruitment Incentives

Not Authorized

Permanent Change of Station (PCS)

Not Authorized

Requirements

Conditions of employment

• You must be a U.S. Citizen to apply for this job.
• 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.
• 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.
• 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.

Qualifications

Applicants pending the completion of educational or certification/licensure requirements may be referred and tentatively selected but may not be hired until all requirements are met. Basic Requirements: United States Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. English Language Proficiency: MRAs must be proficient in spoken and written English. See 38 U.S.C. § 7403(f).

Experience or Education: Experience. Three years of creditable experience in the field of medical records that included the preparation, maintenance, and management of health records and health information systems demonstrating a knowledge of medical terminology, medical records procedures, medical coding, or medical, administrative, and legal requirements of health care delivery systems. OR Education. Successful completion of a bachelor's degree or higher from an accredited college or university recognized by the U.S. Department of Education, with a major field of study in health information management, or a related degree with a minimum of 24 semester hours in health information management or health information technology. OR Experience/Education Combination. Equivalent combinations of [creditable] experience and education that equals 100 percent may be used to meet basic requirements.

Certification. Persons hired or reassigned to MRA positions in the GS-0669 series in VHA must meet one of the following: Coding Certification through AHIMA or AAPC. OR HIM Certification through AHIMA. OR Health Data Analyst Certification through AHIMA. May qualify based on being covered by the Grandfathering Provision as described in the VA Qualification Standard for this occupation (only applicable to current VHA employees who are in this occupation and meet the criteria).

Physical Requirements

See VA Directive and Handbook 5019

Education 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.

Additional information

Receiving Service Credit for Earning Annual (Vacation) Leave: Federal Employees earn annual leave at a rate (4, 6 or 8 hours per pay period) which is based on the number of years they have served as a Federal employee. Selected applicants may qualify for credit toward annual leave accrual, based on prior work experience or military service experience. This credited service can be used in determining the rate at which they earn annual leave. Such credit must be requested and approved prior to the appointment date and is not guaranteed.