MEDICAL RECORDS TECHNICIAN (HEALTH INFORMATION TECHNICIAN)

U.S. Department of Veterans Affairs; Portland (OR); On-site; USD 40,000 - 54,000; Full time

Job summary

The U.S. Department of Veterans Affairs is seeking a Health Information Technician at the VA Portland Health Care System. This role involves reviewing and maintaining health records, ensuring compliance with guidelines, and contributing to the efficient management of patient information. Candidates should have relevant education or experience in health information management and demonstrate strong communication skills.

Qualifications

• Citizenship required: Must be a U.S. citizen.
• Experience in medical terminology and health records required.
• Knowledge of health information compliance standards.

Responsibilities

• Review and analyze health records for completeness and accuracy.
• Monitor compliance with healthcare regulations.
• Support the Release of Information and Scanning Unit.

Skills

Medical Terminology

Health Records Management

Communication Skills

Education

Associate's Degree in Health Information Technology

Tools

Electronic Health Records Software

Microsoft Excel

Job description

This position is located in the Health Information Management (HIM) section at the VA Portland Health Care System (VAPORHCS). Health Information Technicians (HITs) review, analyze, abstract, compile, maintain, and extract information from the health record. Performs additional duties as assigned within the Release of Information and Scanning Unit as needed. They also check for completeness and accuracy of the health record and monitor and report for regulatory compliance.
Duties

The duties of this position include but are not limited to the following:

Requirements

Qualifications

Basic Requirements:

Citizenship: Citizen of the United States. (Non-citizens may be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy.

Experience. One year of creditable experience that indicates knowledge of medical terminology, anatomy, physiology, and a general understanding of health records. Six months of the required one year of creditable experience must have provided the knowledge, skills, and abilities (KSAs) needed to perform MRT HIT work
OR
Education. An associate's degree from an accredited college or university recognized by the U.S. Department of Education, with a major field of study in health information technology/health information management, or a related degree with a minimum of 12 semester hours in health information technology/health information management (e.g., courses in medical terminology, anatomy, physiology, legal aspects of health care, and introduction to health records).
OR
Experience/Education Combination. Equivalent combinations of creditable experience and education are qualifying towards meeting basic experience requirements. The following educational/training substitutions are appropriate for combining education and creditable experience:

Six months of creditable experience that indicates knowledge of medical terminology, privacy and release of information, the health record, and one year above high school with a minimum of six semester hours of health information technology/health information management.

Six months of creditable experience that indicates knowledge of medical terminology, privacy and release of information, the health record, and successful completion of a course for medical technicians, hospital corpsmen, medical service specialists, or hospital training obtained in a training program given by the U.S. Armed Forces or the U.S. Maritime Service, under close medical and professional supervision, may be substituted on a month-for-month basis for up to six months of experience, provided the training program included courses in anatomy, physiology, and health record techniques and procedures.

Grandfathering Provision. All persons employed in VHA as a MRT HIT, are considered to have met all qualification requirements for the grade held, including positive education and licensure/certification/ registration that are part of the basic requirements of the occupation. For employees who do not meet all the basic requirements in this standard, but who met the qualifications applicable to the position at the time they were appointed to it, the following provisions apply:

Such employees in an occupation that does not require a licensure/certification/ registration, may be reassigned, promoted, or demoted within the occupation, but will not be promoted beyond the journey level or placed in supervisory or managerial positions.

Employees appointed on a temporary basis prior to the effective date of the qualification standard may not have their temporary appointment extended, or be reappointed on a temporary or permanent basis, until they fully meet the basic requirements of the standard.

Employees initially grandfathered into this occupation, who subsequently obtain additional education and/or licensure/certification/registration that meet all the basic requirements of this qualification standard, must maintain the required credentials, as a condition of employment in the occupation.

Physical Requirements: See VA Directive and Handbook 5019, Employee Occupational Health Service.

English Language Proficiency. MRTs HIT must be proficient in spoken and written English, as required by 38 U.S.C. § 7403(f).

Grade Determinations:

Medical Records Technician (HIT), GS-4 (Entry Level)
(1) Experience or Education. None beyond basic requirements.
(2) Assignment. Employees at this level serve as entry level MRTs HIT, and receive close supervision from the supervisory MRT HIT or designee.

Medical Records Technician (HIT), GS-5 (Developmental Level 1)
(1) Experience. One year of experience equivalent to the next lower level.
OR,
(2) Education. A bachelor's degree from an accredited college or university recognized by the U.S. Department of Education with a major field of study in health information management, or a related degree with a minimum of 24 semester hours in health information technology/health information management (e.g., courses in medical terminology, anatomy & physiology, legal aspects of health care, and introduction to health records).
(3) Assignment. Employees at this grade level serve in developmental positions as MRTs HIT.
Demonstrated Knowledge, Skills, and Abilities. In addition to the experience above, the candidate must demonstrate all of the following KSAs:
(a) Ability to communicate effectively with internal and external customers
(b) Ability to utilize health information technology and various office software products used in health information management positions (e.g., Microsoft Excel, electronic health records, and delinquency tracking software).
(c) Knowledge of health record documentation guidelines and industry standards.
(d) Ability to manage priorities and coordinate work to complete duties within required timeframes.
(e) Ability to apply knowledge of medical terminology and human anatomy to fully understand the content of a health record

Medical Records Technician (HIT), GS-6
(1) Experience. One year of experience equivalent to the next lower grade level.
(2) Assignment. This is a developmental level for MRT HIT.
(3) Demonstrated Knowledge, Skills, and Abilities. In addition to the experience above, the candidate must demonstrate all of the following KSAs:
(a) Ability to navigate efficiently through the health record to locate needed information.
(b) Ability to analyze health record documentation to ensure compliance with guidelines and industry standards.
(c) Skill in investigating potential health record errors and making corrections, when appropriate.
(d) Skill in interpreting and applying health information guidelines and using judgment to complete assignments.
(e) Ability to follow up on incomplete health record documentation.

Medical Records Technician (HIT), GS-7 (Full Performance Level)
(1) Experience. One year of experience equivalent to the next lower grade level.
(2) Assignment. This is considered the journey level for MRTs HIT.
(3) Demonstrated Knowledge, Skills, and Abilities. In addition to the experience above, the candidate must demonstrate all of the following KSAs:
(a) Ability to judge whether health records contain sufficient information for regulatory requirements, are acceptable as legal documents, are adequate for continuity of patient care, and support education and research needs.
(b) Ability to take appropriate actions if health record content is not adequate, accurate, timely, and/or reliable.
(c) Ability to communicate both orally and in writing with individuals or groups, to facilitate compliance with established policies and regulations.
(d) Skill in using appropriate software and computer applications to analyze and record documentation trends.
(e) Ability to apply qualitative and/or quantitative methods for assessment and improvement of health records.
(f) Ability to work independently and utilize problem-solving techniques in the accomplishment of work.

Preferred Experience: RHIT certification (CPC, RHIT, RHIA CPC or RHIA) preferred. Per National VHA Directive 1907.01(1) 12/11/2023; HIM professionals are highly trained in the latest information management technology applications. HIM professionals are vital to the daily operations management of health information and health records and ensure the quality and accuracy.

Reference: For more information on this qualification standard, please visit https://www.va.gov/ohrm/QualificationStandards/.

The full performance level of this vacancy is GS-4. The actual grade at which an applicant may be selected for this vacancy is in the range of GS-4 to GS-7.