Responsible for the processing, storage and retrieval of the patient’s medical record.
Provides information as appropriate according to the Release of Information policy to internal and external customers through various means including but not limited to written, faxed, mailed and/or secure medical record portals. Retrieves the medical record for the purpose of continuity of patient care, updating patient’s medical record, quality review, and release of information or statistic analysis. Assists in educating physician office staff concerning remote access to EMR and encourage use, able to direct to appropriate staff for additional training/education if requested.
Assembles the medical record. Sequences the record in accordance with assembly procedure. Analyzes the medical record for completeness.
Has the ability to perform intermediate analysis, remove non-automated deficiencies, re-assign deficiencies as needed to appropriate provider and account. Performs final check on the completed record. Utilizes software for an automated chart deficiency system; automated patient index, automated correspondence system, and automated abstract system.
Works with providers and other organizational staff to ensure record completion. This includes the concurrent and retrospective review of the medical record, along with notification to providers and staff regarding incomplete records. Scans the medical record and/or medical record documents for the purpose of storage and/or retrieval.
Process the chart for imaging including but not limited to prepping the documents, scanning the documents, linking the documents to the appropriate account or medical record number and verifying the number of pages. Governs medical record integrity by reporting and/or processing medical record merge requests and performs appropriate record correction procedures. Provides department coverage of other daily tasks on a routine basis as needed or requested.
Qualifications Education Requirements and Other
Education Level: High School diploma or equivalent preferred. Certification/Licensure: None Experience
Computer skills preferred.
Days