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Reporting to the Manager, Health Information Services, the Health Information Management Professional codes and abstracts all inpatient and same day care health records accurately and efficiently. The Health Information Management Professional functions according to CIHI Standards and utilizes the appropriate Coding Classification System.
RESPONSIBILITIES : Overview :
Coding and abstracting of all inpatient and same day care records with adherence to provincial deadlines.
Perform Release of Information, adhering to legislative requirements including the Personal Health Information Act and any other related legislation and policies / procedures.
Perform Privacy Delegate duties as per PMH policies and current legislation.
Identify third party and non-insured patient billings, prepares specific reports and forwards information to business office for invoice preparation; as required.
Perform quantitative and qualitative analysis on each Inpatient / Emergency / SDC Discharge, ensuring the quality, accuracy and completeness of the health record and of the health record data; as required.
Maintain records of physician deficiencies and prints physicians’ reports.
Scan health records into appropriate data systems, as required.
Verify accurate information is on the Admission / Discharge form and collect applicable charges upon discharge of patients; as required.
Assist the Manager, Health Information Services with medical and / or other audits involving the health record as well as medico-legal issues as required.
Establish and maintain a system of standardized chart order, chart retrieval and filing; as required.
Perform Health Information Clerk / Receptionist Clerk functions; as required.
Complete transcription duties; as required.
Respond appropriately to emergency calls / codes; as required.
Greet and direct patients and visitors in an unbiased manner; as required.
Comply with Provincial Productivity Standards re : job performance.