What are the responsibilities and job description for the HIM Trauma Registrar - Trauma Services, University Hospital position at University of South Alabama Health System?
Overview
USA Health is Transforming Medicine along the Gulf Coast to care for the unique needs of our community. USA Health is changing how medical care, education, and research impact the health of people who live in Mobile and the surrounding area. Our team of doctors, advanced care providers, nurses, therapists, and researchers provides the region's most advanced medicine at multiple facilities, campuses, clinics, and classrooms. We offer patients convenient access to innovative treatments and advancements that improve the health and overall well-being of our community.
Responsibilities
- Abides by all compliance requirements and policies and performs these responsibilities in an ethical manner, consistent with the organization's values.
- Adheres to hospital policies including confidentiality.
- Assists with orientation and training of registry staff.
- While registry is concurrent, registrars will be able to round with the trauma team to achieve better abstraction accuracy.
- Reviews Emergency Department registration and/or admission records daily to identify trauma admissions for entry into the trauma registry software. Screens death reports for inpatient, outpatient surgeries, and emergency records for trauma case identification.
- Reviews electronic medical records to assess information required for abstraction. Reviews records for data collection and quality improvement according to standards outlined by the Trauma Medical Director, Trauma Program Manager, and American College of Surgeons.
- Obtains core information for the patients' medical records, specified by the American College of Surgeons, Trauma Medical Director and Trauma Program Manager and enters information into approved software.
- Maintains the confidentiality and security of patient data stored in the Trauma Registry.
- Reports data to Alabama Trauma Registry Massasoit Trauma Realest and the ACS TQIP Programs in accordance
- Participates in performance Improvement activities through quality measurement or participation of PDSA process as assigned.
- Good written and verbal skills
- Completes all mandatory department, educational and hospital requirements
- Adheres to current Infection Control and Safety Standards
- Regular and prompt attendance
- Ability to work schedule as defined and overtime as required
- Related duties as assigned
Additional Information
Employees must be in a regular position, working 20 hours or more per week (.50 FTE or greater) to qualify for benefits.
Qualifications
- High School Diploma or equivalent and 1 year of trauma registry experience. Required
- RHIT - Registered Health Information Technician Preferred or
- RHIA - Registered Health Information Administrator Preferred
- Comparable combination of education and experience may substitute for the above requirements.
Knowledge, Skills, and Abilities
- Knowledge of ICD-10-CM and AIS coding. Completes mandatory 8 hours of registry specific training per year. Knowledge of ICD-10-CM and AIS coding. Completes mandatory 8 hours of registry specific training per year.
Equal Employment Opportunity Employer
The University of South Alabama is an Equal Opportunity Employer and does not discriminate on the basis of race, color, national origin, sex, pregnancy, sexual orientation, gender identity, gender expression, religion, age, genetic information, disability, protected veteran status or any other applicable legally protected basis. EO Employer – minorities/females/veterans/disabilities/sexual orientation/gender identity.