Medical Records Administrator (Chief HIMS)

This position serves as the Supervisory MRA (Chief, Health Information Management Section (HIMS)) of Health Administration Service (HAS) at the Hershel "Woody" Williams VA Medical Center. Supervisory Medical Record Administrators at this grade level are Chiefs of HIMS in VA Medical Centers that are the highest complexity level category for VHA facilities and which are an affiliated, tertiary care facility/health care system with comprehensive research programs.

Qualifications:

Applicants pending the completion of educational or certification/licensure requirements may be referred and tentatively selected but may not be hired until all requirements are met.

BASIC REQUIREMENTS

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

Education or Experience:

• Experience. Three years of creditable experience in the field of medical records that included the preparation, maintenance, and management of health records and health information systems demonstrating a knowledge of medical terminology, medical records procedures, medical coding, or medical, administrative, and legal requirements of health care delivery systems. OR,
• Education. Successful completion of a bachelor's degree or higher 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 management or health information technology. OR,
• Experience/Education Combination. Equivalent combinations of creditable experience and education that equals 100 percent may be used to meet basic requirements. For example, two years above high school from an accredited college or university, with 12 semester hours in health information technology/health information management, plus one year and six months of creditable experience that included the preparation, maintenance, and management of health records and health information systems meets an equivalent combination.

Certification. Persons hired or reassigned to MRA positions in the GS-0669 series in VHA must meet one of the following:

• Coding Certification. Mastery certification obtained through the American Health Information Management Association (AHIMA) or the American Association of Professional Coders (AAPC).
• Health Information Management (HIM) Certification. Higher-level health information management certification is limited to certification obtained through AHIMA.
• Health Data Analyst Certification. This is limited to certification obtained through AHIMA.
• NOTES.
  • See Education Section for detailed definitions of each Certification Type.
  • The full performance level for this qualification standard is non- supervisory GS-11 grade level. HIMs Certification is required for all positions above the full performance level.

Grandfathering Provision. May qualify based on being covered by the Grandfathering Provision as described in the VA Qualification Standard for this occupation (only applicable to current VHA employees who are in this occupation and meet the criteria).

English Language Proficiency. MRAs must be proficient in spoken and written English. See 38 U.S.C. § 7403(f).


GRADE DETERMINATIONS. In addition to the basic requirements for employment, the following criteria must be met when determining the grade of candidates.

Medical Records Administrator (Chief (CHIM)), GS-13

• Experience. One year of creditable experience equivalent to the next lower grade level GS-12 that demonstrates the KSAs described at that level such as: i. Skill in managing various projects and processes, which includes the ability to develop new or improved solutions to complex technical problems in health information management. ii. Ability to advise management and staff on a wide range of health information management practices based on current industry standards, policies, statutes, laws, and regulations. iii. Ability to plan, justify, develop, evaluate, assess, monitor, and/or advise on current health information management processes, and recommend changes in policies or procedures. iv. Ability to determine and evaluate compliance with legal, ethical, and regulatory guidelines, and accrediting bodies as they apply to health information management. v. Ability to successfully apply principles and techniques of sound resource management (i.e., staffing, space, contracts, equipment). vi. Ability to provide the full range of supervisory duties to include assignment of work, completing performance evaluations, selection of staff, and recommendation of awards, advancements, and disciplinary actions.

AND

• Certification. Employees at this level must have a HIM Certification.

AND

• Demonstrated Knowledge, Skills, and Abilities
  • Ability to determine and evaluate compliance with legal, ethical and regulatory guidelines and accrediting bodies, as they apply to health information management.
  • Ability to provide sound, technical guidance to staff [at various levels] about major program, legal, or procedural changes related to health information management.
  • Skill in revising facility policies and procedures to improve health information management services and to evaluate, modify, and/or adapt new methods to meet regulatory requirements.
  • Skill in analyzing complex data, interpreting and trending results for effective management of the HIM program.
  • Skill in management/administration, which includes program planning, coordination, interpretation, supervision, consultation, negotiation, problem solving, and monitoring of HIM processes.
  • Ability to delegate authority, evaluate and oversee people and programs, accomplish program goals, and adapt to changing priorities.

Assignments. This assignment is the Chief Health Information Management (CHIM), which is the highest-level professional position at the facility with responsibility for the management and direction of the health information management program. This assignment is only for the CHIM in VA Medical Centers for all categories (1a, 1b, and 1c) within the complexity level 1 as designated in the VHA, "2014 Facility Complexity Level Model", with full program management and supervisory responsibility to direct professional MRAs, technical MRTs, and other support staff in health information management. CHIMs in this assignment provide technical advice, planning, and evaluation about health information management issues impacting the overall program on a regular and recurring basis.

The CHIM establishes policies, procedures, responsibilities, and requirements for HIM-related matters, such as health record documentation, coding and clinical documentation improvement, release of information, file room/scanning, records management, transcription and medical speech recognition, as well as the overall management of health information and Veterans health records. They oversee development, implementation and adherence to HIM industry standards, policies, procedures, laws, regulations, and accrediting bodies. They ensure the facility is in compliance with applicable standards, by completing HIM audits, developing healthcare data reports, and statistical information, for timely and accurate reporting. The CHIM monitors HIM performance through dashboards, productivity standards, and benchmarking. They participate in establishing and implementing strategic facility and HIM Department goals and controlling program activities and cost, budgeting, procurement, and property management, to achieve goals and improve processes. The CHIM monitors and manages HIM workflow to ensure program objectives are met.

Preferred Experience: HIMS management experience

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

Physical Requirements: Physical aspects associated with work required of this assignment are typical for the occupation, see Duties section for essential job duties of the position. May require standing, lifting, carrying, sitting, stooping, bending, pulling, and pushing. May be required to wear personal protective equipment and undergo annual TB screening or testing as conditions of employment.

Responsibilities:

The MRA is the highest level professional position at the facility with responsibility for the management and direction of the health information management program and services. S/he works at a complex (1c) teaching hospital affiliated with Marshall University and the West Virginia School of Osteopathic Medicine which offers a comprehensive range of services including internal medicine, general and complex surgery, audiology and speech pathology, dental, nutrition, optometry, podiatry, prosthetics, women's health, rehabilitation medicine, geriatrics, primary care, mental health, as well as services at four outpatient clinics.

Functions:
Responsible for the administrative management of health records, which includes planning, managing, advising, and directing the health information program in accordance with applicable Federal laws, facility by-laws, VHA policy, The Joint Commission standards, the Commission on Accreditation of Rehabilitation Facilities (CARF), and other regulatory and accrediting agencies. The Health Information Manager also creates and monitors systems to ensure accurate, timely, and complete health records. Measures ongoing intradepartmental performance by establishing priorities, collecting data, monitoring and reporting outcomes, using valid and reliable techniques to analyze trends and variation, and taking appropriate action based on findings.

Responsible for all facets of health records management for the facility ensuring maintenance of complete, accurate, timely, clinically-pertinent, and readily-accessible patient health records, which contain sufficient recorded information to serve as a basis to plan patient care, support diagnoses, warrant treatment, measure outcomes, support education, research, and facilitate performance improvement processes and legal requirements. Develops policies, processes, and procedures that address all VA, Federal, regulatory, and accrediting requirements for HIM. Evaluates health records program and independently determines the nature and extent of problem areas. Develops recommendations and solutions for program improvement.

The incumbent is a key advisor to the Chief of Staff, Executive Management, and clinicians and is responsible for providing technical guidance on health information issues such as documentation requirements, liability issues, advance directives, informed consent, patient privacy and confidentiality, etc. Represents Health Administration Service (HAS) and acts as subject matter expert at the facility-wide Health Records Committee. In this capacity, the incumbent advises the committee on health record issues; including VA requirements, The Joint Commission standards, record retrieval processes, health record components, systems, goals, electronic records, etc. Incumbent provides direct support to Regional Counsel. The incumbent is also expected to actively participate at VA national and VISN levels as a resource person on health information matters.

The incumbent is a key member of the Quality Improvement (QI) team, works closely with QI personnel, and is responsible for assuring that the facility is in compliance with all The Joint Commission standards regarding health information.

Incumbent is responsible for leading the automation of all health information systems. Working closely with Information Technology (IT) and Clinical Informatics, the incumbent must guide the automation of health record documentation, health record tracking, and physician incomplete record tracking. The incumbent also must support the information security program and manage much of the patient information database within VistA. Incumbent will work with a variety of hardware and software.

As a resource for the institution, incumbent conducts training programs in health information management, medical terminology, health record documentation, and medico-legal matters. Incumbent is responsible for establishing formal affiliation with university programs in health information and precepting students from such programs. Incumbent is also responsible for coordinating health information training for medical school students and residents to achieve conformance with prescribed standards.

The CHIM at this level has the full complement of HIM supervisory responsibility including coding, file room, scanning, release of information, and transcription. Incumbent is responsible for directing the operations of all personnel working within the Health Information program. Performs the administrative and personnel management functions relative to staff supervised.

Work Schedule: FT, 8am - 4:30pm, Monday-Friday
Telework: Ad-hoc telework available as per VA policy and Supervisory discretion.
Virtual: This is not a virtual position.
Functional Statement #: 581-25004-F
Relocation/Recruitment Incentives: Not authorized.
Permanent Change of Station (PCS): Not authorized.

Salary : $106,537