• Applies knowledge of reimbursement methodologies including the Inpatient Prospective payment System (IPPS), Outpatient Prospective Payment System (OPPS), Ambulatory Payment Groups (APGs), Medicare Severity Diagnosis Related Groups (MS_DRG), and the Veteran Equitable Resource Allocation (VERA) to ensure correct code assignment.
• Collaborates with coding, clinical and administrative staff providing technical support and routine education on identified issues. 
• Assists in the development of policies, guidelines and standard operating procedures to ensure integrity of clinical, financial and administrative data. 
• Identifies and determines training priorities, developing training programs that meet the needs of the medical facility. 
• Creates training tools that are informative, accurate, engaging and meet the learning styles of each individual. 
• Conducts extensive research from diverse sources to assure that educational materials are based on current VHA Directives and Regulations.
• Monitors healthcare encounters, review and report of action required cases, making appropriate adjustments and providing technical advice and support regarding the repair of discrepancies in the documentation or the processing of billable encounters for both inpatient and outpatient encounters.
• Plans, organizes, directs and controls areas with emphasis on data validation, analysis and generation of reports associated with the facility's Health Information Management Quality and Education program. 
• Assures CPT/HCPCS and ICD-10-CM codes, DRGs, and APGs are supported by clinical and physician documentation for accurate and reliable data collection and reimbursement. 
• Provides support and education on documentation issues and assists in the development of guidelines for data compatibility, consistency and monitoring for Quality and Education to improve the quality of clinical, financial and administrative data to assure that every part of the information is completely documented and supported. 
• Performs quantitative and qualitative review and analysis of health records and encounter information of outpatient and inpatient both concurrently and retrospectively, to ensure documentation in both is accurate, consistent, and complete and assigned codes can be supported by the documentation.
• Researches the impact of coding changes and issues coding alerts addressing concerns, target areas, etc. works to improve facility performance and quality measures to include Strategic Analytics for Improvement and Learning (SAIL) and Veterans Equitable Resource Allocation (VERA) classification and funding.
• Provides coding and documentation advice to coding, clinical, and professional staff.  
• Provides and assists in the performance of training, in-services and other educational activities to staff regarding diagnosis and procedure code assignment, government regulatory requirements, and use of encoder software and to secure regulatory Quality and Education and data quality goals.
• Provides guidance and counsel on the incorporation of standard Quality and Education related activities into operational areas. 
• Maintains collaborative working relationships with the Facility Revenue Manager, Health Information Management, Medical and Allied Health Professional Staff, Regional Counsel, Executive Leadership, and other key stakeholders in the Medical Center.  
• Participates in external reviews of the organization surveys (the Joint Commission, IG/CAP, GAO) as directed by Medical Center executive leadership. 
• Directly responsible for the monitoring of specific, facility-wide, clinical data from various sources such as consolidated health records, computerized patient record systems, diagnostic and therapeutic indices or clinical logs and making corrections to electronic encounters that were previously rejected. 
• Providing technical support and recommendations in various clinical data management scenarios, conducting data collection and continuous monitoring for performance improvement projects and maintaining timely and accurate submission of relevant reports. 
• Performs quantitative and qualitative analysis of electronic data.
• Works closely with Providers, Care Line Managers, ancillary, clinical and administrative staff of internal clinics as well as Community Based Outpatient Clinics (CBOC) to ensure any and all encounter submissions are successfully completed.  
• Provides technical staff support of the Health Information Management for the administration of the VAMC Martinsburg health information management program.  
• Assists professional personnel in the creation and development of electronic encounter forms to ensure proper submission of data in order to assure maximum reimbursement, and to provide the most accurate information in accordance with CMS and industry standards.

Work Schedule: Monday - Friday 8:00 am to 4:30 pm
Functional Statement Title/#: Medical Records Administrator (HIMS Quality and Education Specialist)/000000

Conditions of employment

• Must pass pre-employment examination
• Must be proficient in written and spoken English
• Designated and-or Random Drug Testing required
• Background and-or Security Investigation required
• Selective Service Registration is required for males born after 12/31/1959.
• VA Form 10-2850C - Application for Associated Health Occupations

Physical Requirements:Position is primarily sedentary.

Qualifications

BASIC QUALIFICATION REQUIREMENTS:

A.  Citizenship - Citizen of the United States. 

B.  Experience and Education

Experience - Three years of experience in the field of medical records that included the preparation,  maintenance, and management of medical records and health information systems.  At least 1 year of this  experience must be comparable to a GS-4 level position.

An associate's degree in the health information field plus 1 year of experience that included the
preparation, maintenance, and management of medical records and health information systems.

NOTE:  Successfully completed training for health information technicians in a school accredited by the American Health Information Management Association (AHIMA) at the time the program was completed may be substituted for 1 year of experience.  No credit may be given for partial completion of such training.

OR

Education - Education equivalent to a baccalaureate degree from an accredited university or college. 

OR

Experience/Education Combination - Equivalent combinations of experience and education may be used to meet  basic requirements.

C.  Physical Requirements - Applicants for this position may be asked to pass a pre-employment medical examination.   Must be medically qualified to discharge the duties and responsibilities of this position and capable of complying with all applicable laws, regulations, and procedures.

D.  English Language Proficiency – Medical Record Administrators must be proficient in spoken and written English.

GRADE REQUIREMENTS:

Creditable Experience
(a) Knowledge of Current Medical Record Administration Practices. To be creditable, experience must have required the use of knowledge, skills, abilities, and other characteristics (also referred to as "core competencies") associated with current health information practice. This knowledge may be evidenced by one or more of the following:
1. The equivalent of 1 year of active practice in the health information management field that included knowledge of the content and uses of health records, computerized information systems, and disease and procedural indices; ability to apply the concepts, principles and practices of health information administration; ability to apply knowledge of anatomy, pathophysiology, and medical terminology to health information management functions.
OR,
2. Maintenance/possession of an active credential from AHIMA as a Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT);
OR,
3. Successful completion of academic course work leading to an advanced degree in health information management or a related field.
(2) Quality of Experience. Experience is only creditable if it is in health information management and is directly related to the position to be filled or in a related field, such as quality assurance, Health Insurance Portability & Accountability Act (HIPAA) privacy, or electronic medical record implementation. Qualifying experience must also be at a level and complexity comparable to medical record management experience at the next lower grade level. Registration is offered by AHIMA as a Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) and is highly desirable.
(3) Part-Time Experience. Part-time experience as a medical record administrator is creditable according to its relationship to full-time workweek. For example, an MRA would receive 1 week of full-time credit for each 2 weeks of half-time work.

Grade Determinations. In addition to the basic requirements for employment, the following criteria must be met when determining the grade of candidates.
GS-11

Experience. At least 1 year of experience comparable to the next lower grade level that demonstrates the KSAs described at that level. In addition, the candidate must demonstrate the following KSAs:
1. Skill in project management and process improvement, which includes the ability to develop new or improved solutions to complex technical problems in health information management;
2. Ability to advise management and staff about adequate medical record documentation, health information services, and/or computerized patient records based on current statutes and standards;
3. Ability to plan for, justify, test, assess, and/or advise about the use of current and future software programs or information systems, implement and integrate such products into current health information management processes, and recommend changes in policies or procedures;
4. Ability to interpret, implement, and apply knowledge of privacy and confidentiality requirements affecting individual patient/protected health information;
5. Demonstrated comprehensive knowledge of medical and legal requirements related to both paper and electronic medical records;
6. Ability to communicate and negotiate with professionals in higher level positions;

OR

Education. Education equivalent to 3 full years of progressively higher level graduate education or a Ph.D. or equivalent doctoral degree from an accredited university or college in the field of health information.

Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religions; spiritual; community; student; social).  Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment.  You will receive credit for all qualifying experience, including volunteer experience.

References: VA Handbook 5005/55,Part II, Appendix G33 MEDICAL RECORDS ADMINISTRATOR QUALIFICATION STANDARD , dated March 17, 2006. 

How you will be evaluated

You will be evaluated for this job based on how well you meet the qualifications above.

IN DESCRIBING YOUR EXPERIENCE, PLEASE BE CLEAR AND SPECIFIC. WE MAY NOT MAKE ASSUMPTIONS REGARDING YOUR EXPERIENCE.

Your application, résumé and/or supporting documentation will be verified.  Please follow all instructions carefully.  Errors or omissions may affect consideration for employment.

NOTE:  The Professional Standards Board (a peer-review group) will recommend the grade and salary for new appointments.