Medical Records And Health Information Technicians

Medical Records and Health Information Technicians

Description

Compile, process, and maintain medical records of hospital and clinic patients in a manner consistent with medical, administrative, ethical, legal, and regulatory requirements of the health care system. Process, maintain, compile, and report patient information for health requirements and standards in a manner consistent with the healthcare industry's numerical coding system.

Tasks

Protect the security of medical records to ensure that confidentiality is maintained.
Review records for completeness, accuracy, and compliance with regulations.
Retrieve patient medical records for physicians, technicians, or other medical personnel.
Release information to persons or agencies according to regulations.
Plan, develop, maintain, or operate a variety of health record indexes or storage and retrieval systems to collect, classify, store, or analyze information.
Enter data, such as demographic characteristics, history and extent of disease, diagnostic procedures, or treatment into computer.
Compile and maintain patients' medical records to document condition and treatment and to provide data for research or cost control and care improvement efforts.
Process and prepare business or government forms.
Process patient admission or discharge documents.
Assign the patient to diagnosis-related groups (DRGs), using appropriate computer software.
Transcribe medical reports.
Identify, compile, abstract, and code patient data, using standard classification systems.
Resolve or clarify codes or diagnoses with conflicting, missing, or unclear information by consulting with doctors or others or by participating in the coding team's regular meetings.
Compile medical care and census data for statistical reports on diseases treated, surgery performed, or use of hospital beds.
Post medical insurance billings.
Train medical records staff.
Prepare statistical reports, narrative reports, or graphic presentations of information, such as tumor registry data for use by hospital staff, researchers, or other users.
Manage the department or supervise clerical workers, directing or controlling activities of personnel in the medical records department.
Develop in-service educational materials.
Consult classification manuals to locate information about disease processes.

Knowledge

Clerical: Knowledge of administrative and clerical procedures and systems such as word processing, managing files and records, stenography and transcription, designing forms, and other office procedures and terminology.
Customer and Personal Service: Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.
English Language: Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
Computers and Electronics: Knowledge of circuit boards, processors, chips, electronic equipment, and computer hardware and software, including applications and programming.
Law and Government: Knowledge of laws, legal codes, court procedures, precedents, government regulations, executive orders, agency rules, and the democratic political process.

Skills

Active Listening: Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
Reading Comprehension: Understanding written sentences and paragraphs in work related documents.
Writing: Communicating effectively in writing as appropriate for the needs of the audience.
Speaking: Talking to others to convey information effectively.
Critical Thinking: Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
Monitoring: Monitoring/Assessing performance of yourself, other individuals, or organizations to make improvements or take corrective action.

Abilities

Near Vision: The ability to see details at close range (within a few feet of the observer).
Oral Comprehension: The ability to listen to and understand information and ideas presented through spoken words and sentences.
Oral Expression: The ability to communicate information and ideas in speaking so others will understand.
Written Comprehension: The ability to read and understand information and ideas presented in writing.
Speech Recognition: The ability to identify and understand the speech of another person.
Information Ordering: The ability to arrange things or actions in a certain order or pattern according to a specific rule or set of rules (e.g., patterns of numbers, letters, words, pictures, mathematical operations).

Work Activities

Establishing and Maintaining Interpersonal Relationships: Developing constructive and cooperative working relationships with others, and maintaining them over time.
Organizing, Planning, and Prioritizing Work: Developing specific goals and plans to prioritize, organize, and accomplish your work.
Getting Information: Observing, receiving, and otherwise obtaining information from all relevant sources.
Interacting With Computers: Using computers and computer systems (including hardware and software) to program, write software, set up functions, enter data, or process information.
Identifying Objects, Actions, and Events: Identifying information by categorizing, estimating, recognizing differences or similarities, and detecting changes in circumstances or events.
Making Decisions and Solving Problems: Analyzing information and evaluating results to choose the best solution and solve problems.
Updating and Using Relevant Knowledge: Keeping up-to-date technically and applying new knowledge to your job.

Work Context

Indoors, Environmentally Controlled: How often does this job require working indoors in environmentally controlled conditions?
Telephone: How often do you have telephone conversations in this job?
Importance of Being Exact or Accurate: How important is being very exact or highly accurate in performing this job?
Face-to-Face Discussions: How often do you have to have face-to-face discussions with individuals or teams in this job?
Contact With Others: How much does this job require the worker to be in contact with others (face-to-face, by telephone, or otherwise) in order to perform it?
Structured versus Unstructured Work: To what extent is this job structured for the worker, rather than allowing the worker to determine tasks, priorities, and goals?
Importance of Repeating Same Tasks: How important is repeating the same physical activities (e.g., key entry) or mental activities (e.g., checking entries in a ledger) over and over, without stopping, to performing this job?
Spend Time Using Your Hands to Handle, Control, or Feel Objects, Tools, or Controls: How much does this job require using your hands to handle, control, or feel objects, tools or controls?
Time Pressure: How often does this job require the worker to meet strict deadlines?
Electronic Mail: How often do you use electronic mail in this job?

Interests

Conventional: Conventional occupations frequently involve following set procedures and routines. These occupations can include working with data and details more than with ideas. Usually there is a clear line of authority to follow.
Enterprising: Enterprising occupations frequently involve starting up and carrying out projects. These occupations can involve leading people and making many decisions. Sometimes they require risk taking and often deal with business.
Social: Social occupations frequently involve working with, communicating with, and teaching people. These occupations often involve helping or providing service to others.
Realistic: Realistic occupations frequently involve work activities that include practical, hands-on problems and solutions. They often deal with plants, animals, and real-world materials like wood, tools, and machinery. Many of the occupations require working outside, and do not involve a lot of paperwork or working closely with others.
Investigative: Investigative occupations frequently involve working with ideas, and require an extensive amount of thinking. These occupations can involve searching for facts and figuring out problems mentally.
Artistic: Artistic occupations frequently involve working with forms, designs and patterns. They often require self-expression and the work can be done without following a clear set of rules.

Work Style

Attention to Detail: Job requires being careful about detail and thorough in completing work tasks.
Integrity: Job requires being honest and ethical.
Dependability: Job requires being reliable, responsible, and dependable, and fulfilling obligations.
Independence: Job requires developing one's own ways of doing things, guiding oneself with little or no supervision, and depending on oneself to get things done.
Cooperation: Job requires being pleasant with others on the job and displaying a good-natured, cooperative attitude.
Adaptability/Flexibility: Job requires being open to change (positive or negative) and to considerable variety in the workplace.
Self Control: Job requires maintaining composure, keeping emotions in check, controlling anger, and avoiding aggressive behavior, even in very difficult situations.
Concern for Others: Job requires being sensitive to others' needs and feelings and being understanding and helpful on the job.
Initiative: Job requires a willingness to take on responsibilities and challenges.
Stress Tolerance: Job requires accepting criticism and dealing calmly and effectively with high stress situations.

Work Values

Relationships: Occupations that satisfy this work value allow employees to provide service to others and work with co-workers in a friendly non-competitive environment. Corresponding needs are Co-workers, Moral Values and Social Service.
Support: Occupations that satisfy this work value offer supportive management that stands behind employees. Corresponding needs are Company Policies, Supervision: Human Relations and Supervision: Technical.
Independence: Occupations that satisfy this work value allow employees to work on their own and make decisions. Corresponding needs are Creativity, Responsibility and Autonomy.
Working Conditions: Occupations that satisfy this work value offer job security and good working conditions. Corresponding needs are Activity, Compensation, Independence, Security, Variety and Working Conditions.
Achievement: Occupations that satisfy this work value are results oriented and allow employees to use their strongest abilities, giving them a feeling of accomplishment. Corresponding needs are Ability Utilization and Achievement.
Recognition: Occupations that satisfy this work value offer advancement, potential for leadership, and are often considered prestigious. Corresponding needs are Advancement, Authority, Recognition and Social Status.

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National Wages and Employment Info

Median Wages (2008):: $16.42 hourly, $34,160 annual.

Employment (2008):: 182,370 employees