Medical Records Non Licensed

Medical Records Non Licensed Northwest Nursing Center - 3.2 Oklahoma City, OK Job Details Part-time 13 hours ago Qualifications Writing skills English High school diploma or

GED ICD-9

Medical terminology Full Job Description

JOB SUMMARY

The Medical Records Department participates in all activities related to the establishment, maintenance, and closing of resident medical records in accordance with facility policies and regulations.

EDUCATION

High School diploma required. Medical Records certification preferred, but not required. Must continue to maintain background checks in good standing according to the requirements of Texas Department of Aging & Disability Services (DADS).

QUALIFICATIONS

Must have computer skills and knowledge in filing, medical terminology, ICD-9 coding, and other clerical functions. Strong organizational skills and attention to detail. Considerable initiative and judgment is needed. Must be able to communicate in English, both verbally and in writing, and possess sufficient communication skills to perform the tasks required.

RESPONSIBILITIES

Sets up residents medical records; collects information from nursing staff, physicians and other sources, updates records, thins charts, and closes charts when necessary. Monitors and audits records for completeness and accuracy, and thins charts in accordance with facility policy and regulations. Processes transfer or discharge records and maintains appropriate records on former residents. Assists with all medical record requests from residents, family members, insurance companies, legal authorities, etc. according the company policy. May assist in the ordering, stocking, and maintaining inventory of nursing supplies. Ensures understanding of, and compliance with, all rules regarding residents rights and HIPAA regulations. Performs other duties as assigned by Supervisor.

PHYSICAL DEMANDS

Use the percentages range as follows: 0% Never 1 33% Occasionally 34 66% Frequently 67 100% Continuous Requires full range of body motion including: 1.

Standing/Walking:

Frequently:

Administrative filing; running off copies on copier; faxing copies; delivering/retrieving documents as necessary. 2.

Bending/Stooping:

Frequently:

Worker will be bending and stooping as he/she is filing documents, reloading copier and computer with paper. 3.

Lifting/Handling:

Occasionally:

Worker will be lifting and handling when restocking nursing supplies, filing resident records (active and inactive).

Range of weight:

1-50 pounds. 4.

Carrying:

Occasionally:

Worker will carry documents and administrative/nursing supplies.

Range of weight:

1-50 pounds 5.

Balancing:

Occasionally:

Moving supplies from one storage room to another, resident file folders from active to inactive. 6.

Pivoting/Turning:

Occasionally:

Stocking supplies and forms. Copying, handling records, file folders, etc. 7.

Crouching/Stooping:

Occasionally:

Storing resident files, folders, supplies; inventory for nursing department. 8.

Kneeling:

Occasionally:

Filing, stocking supplies. 9.

Reaching:

Frequently:

Frequently:

Frequently:

Filing administrative folders, records, etc. A. Greater than shoulder height B. Equal to Shoulder height C. Less than shoulder height 10.

Manual Dexterity:

Continuously:

Continuous data entry, copier, fax machine. 11.

Speaking/Hearing Seeing:

Continuously:

Answering phone, conversing with residents as well as employees and family members.

JOB LOCATION

May work throughout all areas of the facility including the administrative office and nurses stations. May be exposed to communicable disease and/or bodily fluids, medical preparations, toxic substances and ionizing radiation.