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Job Summary

The HIM Clerk (Medical Records Clerk) is responsible for managing the medical records of the facility, including preparing, storing, and retrieving patient health records. The medical record clerk reviews medical records for compliance within approved policies.

Essential Duties:

• Prepares new patient charts, gathering documents and information from paper sources and/or electronic health record.
• Ensures medical records are assembled in standard order and are accurate and complete.
• Creates digital images of paperwork to be stored in the electronic medical record.
• Files paperwork and reports in patient charts, ensuring they are completed in an accurate and timely manner.
• Ensures files are stored in the designated area according to storage procedures.
• Responsible for safeguarding patient records and ensuring compliance with HIPAA standards.
• Responds to requests for patient records, both within the facility and by external sources, retrieving them and transmitting them appropriately.
• Retrieves medical records from offsite chart storage facilities when needed.
• Performs other clerical tasks as needed, such as answering phones, faxing, and patient check in and out.

Requirements

Education and/or Licensure High School degree or equivalent required.

Experience A minimum of one (1) year experience in a healthcare environment preferred with previous medical office experience.

Additional Requirements None

Knowledge Skills and Abilities

• Ability to accurately enter data, prepare and maintain records, files, and reports.
• Outstanding skills in giving attention to details with display of dexterity in maintaining confidentiality.
• Knowledge of HIPAA medical privacy regulations and practices.
• Understanding of medical terminology
• Must have advanced PC skills that include a combination of working in a Windows Operating System and Microsoft Outlook, Word and Excel as well as ability to use financial software and payroll systems (Kronos a plus).
• Communicate effectively with a variety of individuals and function calmly in situations, which require a high degree of sensitivity, tact, and diplomacy.
• Ability to exercise appropriate judgment in answering questions and releasing information; analyze and project consequences of decisions and/or recommendations.
• Skill to independently interpret reference materials to comply with law, rules, regulations, policies, procedures, etc.
• Ability to apply time management practices to prioritize, schedule and complete work effectively to comply with mandated policies and deadlines.
• Ability to work on multiple tasks or parts of tasks simultaneously to ensure timely completion of work activities.

Physical Requirements/Environmental Conditions

Perform the following with or without reasonable accommodations:

• Ability to stoop, kneel, crouch, crawl, reach, stand, walk, push, pull, lift, grasp, and be able to perceive the attributes of objects such as size, shape, temperature, and/or texture by touching with skin, particularly that of the fingertips.
• Ability to express and exchange ideas via spoken word during activities in which they must convey detail or important spoken instructions to others accurately, sometimes quickly and loudly.
• Hearing to perceive the nature of sound with no less than 40 db loss @ Hz, 1000 Hz, and 2000 Hz with or without correction; ability to perceive detailed information orally and make fine discriminations in sound.
• Perform repetitive motions with wrists, hands, and fingers. Individual must be able to exert up to 100 pounds of force occasionally and to be able to lift, carry, push, pull, or otherwise move objects.
• Work requires a minimum standard of visual acuity with or without correction that will enable people in the role to complete administrative and clerical tasks, as well as inspect and analyze.
• Must be able to work and concentrate amidst distractions such as noise, conversation and foot traffic; ability to handle interruptions often and be able to move from one task to another
• While worker may possibly be subjected to temperature changes, the worker is generally not substantially exposed to adverse environmental conditions as the work is predominantly inside.