Job Description

This position is contingent upon award

International Health and Medical Services is looking for an experienced Medical Records Technician to accurately manage and maintain patient health records, ensuring that all documentation is complete, organized, and compliant with legal and regulatory requirements. This role involves coding medical information for billing purposes, facilitating access to medical records for healthcare providers, and protecting patient confidentiality.

• Prepare, update, and maintain a medical record for each patient ensuring accuracy of information.
• Maintain appointment system for patients and clinical staff.
• Track compliance with internally scheduled patient appointments, making timely reminder notices to staff prior to each appointment.
• File, scan laboratory, radiology, and other reports in appropriate sections of the electronic medical record within prescribed timeline.
• Route clinical reports to appropriate clinic staff within prescribed timeline.
• Archive clinical information from the medical record within prescribed timeline in accordance with established policy and procedures. 7.
• Review all documentation for completeness and route incomplete documents to the appropriate provider for correction prior to scanning in the medical records.
• Use multiple systems to process a variety of narrative and tabular material (e.g., correspondence, tabular data, reports, etc.) to prepare, update, and maintain a medical record and provide required and requested information to appropriate medical personnel.
• Perform record keeping functions in accordance with program policies and position.
• Maintain a high level of proficiency and ease of use utilizing electronic health records.
• Complete and pass Medical Records Technician competencies initially and annually.
• Complete all initial, annual and ad hoc training as required or assigned.
• Serves as a team member for analyzing established protocol practices and identify areas for improvement.
• Maintain patient confidentiality, and confidentiality of medical records in compliance with the Privacy Act and HIPAA regulations in all work activities.
• Adhere to and maintain awareness of; Policies, Procedures, Directives, Operational Memoranda and accreditation standards as prescribed.
• Adhere to and participate in: Safety, Prevention, Infection and Control, Quality Improvement, Patient Education and other programs and collateral duties as appropriate to position.
• Attend and participate in general and medical staff meetings.
• Utilize knowledge of the basic principles of standard electronic medical record procedures, methods, and requirements to perform a full range of routine medical records management.
• Apply knowledge of the procedures, rules, operations, sequence of steps, documentation requirements, time requirements, functions, and workflow to process electronic medical records, to review records for accuracy and completeness, and to keep track of processing deadlines.
• Utilize knowledge of medical terminology.
• Manage high volume of medical records daily to include intake, discharge, and requests for records from outside sources.
• Receive and process requests for information in accordance with the Fair Information Practice Principles and Privacy Act.
• Recognize documentation inconsistencies and take appropriate action to resolve.
• Maintain an electronic medical record system and ensure compliance with all regulatory agencies that provide governance and guidance on handling medical records in an appropriate manner.
• Work in a multi-cultural and multi-lingual environment.
• Ability to work with computers, scanners, and printers.
• Utilize telephonic interpreter translation services to complete assigned duties if not fluent in a language the patient understands.
• Adapt to sudden changes in schedules and flexibility in work requirements.
• Communicate proficiently in English (verbal and written) in order to develop positive rapport with patients, co-workers and other stakeholders.
• Establish and maintain positive working relationships in a multidisciplinary environment.
• Navigate in an electronic work environment including electronic health records, web-based trainings, and communications.
• Have functional proficiency in common Microsoft Office programs, specifically Microsoft Word, Excel, Outlook, and SharePoint.
• Apply knowledge of regulations (HIPAA/Privacy Act) regarding the confidentiality of patient medical records and information as well as Personally Identifiable Information (PII).
• Demonstrate cultural sensitivity in all communications with coworkers and clients, fostering an inclusive and respectful work environment that values diversity.
• Complete required organizational compliance education, including assigned requirements that are client-specified, for Joint Commission Healthcare Staffing Services certification or other regulatory bodies.

This list is non-exhaustive, and the role holder may be required to undertake additional duties that are not specifically listed above.

Qualifications

Basic Requirements/Certifications:

• Minimum of one-year experience in a healthcare setting as a medical record technician, medical record clerk, unit secretary, or similar position where the processing of electronic medical/health records was part of the daily responsibilities.
• Minimum of one-year direct experience with proficiency in Microsoft Office programs, specifically MS Word, Excel, Outlook, SharePoint.
• Basic Life Support (BLS) required. If not American Heart Association (AHA) certified, must be within first year.
• Trained in Basic First Aid.
• Employees shall have at least one year of general experience that demonstrates the following:
  • The ability to greet and deal tactfully with the public.
  • Capability of understanding and applying written and verbal orders, rules, and regulations. All personnel shall be literate and be able to interpret printed rules and regulations, detailed written orders, training instructions and materials, and must be able to compose reports.
  • Good judgment, courage, alertness, an even temperament, and render satisfactory performance through knowledge of his/her position responsibilities.
  • Ability to maintain poise and self-control during situations that involve mental stress, such as fires, explosions, civil disturbances, and building evacuations.

Education Required:

• High School Diploma or GED equivalent.

• Attributes and Professional Qualities:

• Strong oral and written communication skills.

• Excellent interpersonal skills.

• Critical thinking skills.

• Cultural competency.

• Integrity and honesty.

• Verbal and written proficiency in Spanish (preferred, not required).

• Experience in a detention or correctional or residential healthcare setting (preferred, not required).

Physical Requirements:

• Required to walk unaided at a normal pace for up to 5 minutes and maintain balance.
• Required to jog/fast walk up to ¼ mile.
• Requires physical exertion such as lifting objects greater than 30 pounds.
• Required to perform CPR/emergency care standing or kneeling.
• Must have the ability to assist sick, injured, or aging patients or staff exiting the building (may require lifting, dragging, wheeling, or carrying someone who weighs significantly more than self).
• Must be able to see, hear and smell with aids if necessary.
• Must be able to lift, push, or carry 30 pounds.
• Must perform the duties of my job in a stressful and often austere environment without physical limitations.
• Sitting and/or standing for extended periods of time.
• Average manual dexterity for computer operation.
• Phone or computer use for extended periods of time.

Other Special Qualifications:

• Must maintain current/physical residency in the continental U.S.
• Pass a medical examination conducted by a licensed physician within 30 days prior to initial assignment.
• U.S. citizen and have resided in the U.S. for the last five years (unless abroad on official U.S. government duty).
• Successfully engage in and complete a thorough Background Investigation.
• Poses or have ability to obtain required security clearances.
• Proficiency in Spanish is preferred.

Additional Information

Pay range is based on several factors and may vary in addition to a full range of medical, financial, and/or other benefits. Final salary and offer will be determined by the applicant’s background, experience, skills, internal equity, and alignment with geographical market data.

Benefits – Full-time positions are eligible for our comprehensive and competitive benefits package including medical, dental, vision, and basic life insurance. Additional benefits include a 401k plan paid time off and an annual bonus. International Health and Medical Services complies with all federal, state, and local minimum wage laws

International Health and Medical Services is an equal opportunity employer and does not discriminate against employees or job applicants on the basis of race, color, religion, gender, sexual orientation, gender identity, national origin, age, disability, genetic information, marital status, amnesty or status as a covered veteran in accordance with the applicable federal, state and local laws.