QUALIFICATIONS:

• Knowledge/Skills/Abilities:
• Performs basic medical record functions such as filing, scanning, release of information, coordination of transcription, assembly of discharged records, and analysis of discharged records for physician and other interdisciplinary team member deficiencies.

• Assists HIM Manager in assigning diagnoses/procedures codes to medical records using ICD-10-CM coding system as needed.
• Works with physicians and other clinical staff to clarify diagnoses and/or documentation issues relating to coding including notifying physicians of deficiencies, including time requirements for completion
• Serves as a coding resource to other hospital staff that might have questions regarding the meaning of certain codes.
• Performs regular medical record audits.

• Assists with review and updates to HIM policies and procedures
• Stays current with all coding changes pertaining to the inpatient rehabilitation environment.
• Responsible for maintaining confidentiality of all patient information.
• Assists with the Medical staff Credentialing process
• Participates in the overall quality assessment and improvement activities and relevant training programs.
• Assists in preparing reports for committee functions.
• Perform other related duties and activities as directed and assigned by the Health Information Manager
• High School Diploma or GED
• Excellent oral and written communication and interpersonal skills.

• Knowledge and experience with Medical Records is required.

• Knowledge and experience with Medical Coding is preferred, but not required.