This position serves as a Medical Records Technician (MRT) in the Release of Information (ROI) Section and is under the supervision of the Chief, Health Information Management. The occupation involves technical work concerned with processing and maintenance of medical record.

Duties

The duties in this position are primarily advisory and technical in nature. Incumbent is responsible for evaluating the adequacy of each completed authorization form. Screens each request for information to determine urgency and assures that most urgent requests are completed first using established priority systems. Personally greets veterans/visitors and assists them in determining the exact nature of the request and whether the information requested can be released. Applies public laws, rules, regulations and exclusions governing confidentiality of the medical record, including the Privacy Act, Freedom of Information Act and 38 U.S.C. 7332 governing the release of records containing information regarding the treatment of or referral for drug and/or alcohol abuse, Sickle Cell Anemia and infection with Human Immunodeficiency Virus (HIV). The incumbent processes all incoming requests to the facility for Release of Information (ROI) along with information required by the VA Regional Office through the Automated Medical Information Exchange (AMIE), referring only problem cases to the Supervisor. Evaluates validity of each request. Determines which information is to be released in compliance with existing laws (Privacy Act of 1974, Freedom of Information Act, and Health Insurance Portability and Accountability Act). Ensures that proper authorization exists before release is made. Processes the request to the requesting agency or individual. Inputs all requests into the ROI computer package for logging and tracking of these requests. Receives and directs callers and visitors. Receives and/or gives out forms and assists visitors and/or callers with the completion of forms or documents. Responds to questions from patients concerning services. Provides advisory and technical assistance to patients, administrative staff and professional staff regarding release of information. Inquiries vary widely and information given requires explanation of office functions, describing specific requirements, providing basic instructions, or a similar degree of detail. Searches records or files to compose responses, including electronic searches to retrieve and summarize hard-to-locate data. Locates materials that would verify information given. Reviews paper and computerized health records (i.e., scanned notes, reports, special tests, etc.) to identify material to be photocopied/printed/written to electronic media and released. Employee composes responses to routine requests for release of patient information. Selects and compiles information from health records and prepares correspondence, typically using standard form or standard formats for letters. Ensures the information released is limited to what is specifically authorized and to the person or agency designated to receive it. Composes detailed explanations in response to correspondence received, arranging information into logical sequence and appropriate format and choosing appropriate words and expressions to convey the desired tone. Determines extent and tone of replies independently. Resolves conflicting or inconsistent information found on initial requests. This involves dealing with patients and/or third parties to resolve discrepancies, sorting out errors and reconstructing past transactions, cases or events, or finding alternative sources of information. Replies to vague, incomplete, or ambiguous inquires by independently recognizing issues, topics or problems. Inquiries are usually presented by patients or third parties who are not sure what information they are looking for or do not know how to identify it by title. Finds alternative sources of information on which to base a reply when correspondent has provided sketchy or inaccurate information. Processes Social Security requests for health information using ROI software. Downloads VistA Imaging documents and ROI software documents onto a secure Network Drive. Completes and processes routine releases of information to other VA and Federal Agencies and when requested, to patients and their families, insurance representatives, physicians, hospitals, and city and state health agencies according to VA directives. Processing must be accomplished within established time standards. Accurately enters all requests into the ROI software with necessary information for each request for health information. Completes necessary transactions for deposit of money collected from subpoena, legal fees, and processing fees for release of information to individuals and insurance companies. Work Schedule: Monday-Friday, 7:30am-4:00pm Telework: Available Virtual: This is not a virtual position. Functional Statement #: 000000 Relocation/Recruitment Incentives: Not Authorized Permanent Change of Station (PCS): Not Authorized

Requirements

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. Experience and Education: Experience. One year of creditable experience that indicates knowledge of medical terminology and general understanding of health records. Six months of the required one year of creditable experience must have provided the knowledge, skills, and abilities (KSAs) needed to perform MRT (ROI) work. OR Education. An associate degree from an accredited college or university recognized by the U.S. Department of Education with a major field of study in health information technology/health information management, or a related degree with a minimum of 12 semester hours in health information technology/health information management (e.g., courses in medical terminology, anatomy and physiology, legal aspects of health care, and introduction to health records). OR Experience/Education Combination. Equivalent combinations of creditable experience and education are qualifying towards meeting basic experience requirements. The following experience and educational/training substitutions are appropriate for combining education and creditable experience: (a) Six months of creditable experience that indicates knowledge of medical terminology, privacy and release of information, the health record, and one year above high school with a minimum of six semester hours of health information technology/health information management courses. (b) Six months of creditable experience that indicates knowledge of medical terminology, privacy and release of information, the health record, and successful completion of a course for medical technicians, hospital corpsmen, medical service specialists, or hospital training obtained in a training program given by the Armed Forces or the U.S. Maritime Service under close medical and professional supervision. The training program may be substituted on a month for-month basis for up to six months of experience provided the training program included courses in anatomy and physiology, and health record techniques and procedures. English Language Proficiency. MRTs (ROI) must be proficient in spoken and written English, as required by 38 U.S.C. § 7403(f). 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). Grade Determinations: GS-4 Medical Records Technician (ROI) Experience or Education. None beyond basic requirements. GS-5 Medical Records Technician (ROI)Experience. One year of creditable experience equivalent to the next lower grade level; OR Education. Successful completion of a bachelor's degree 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 technology/health information management (e.g., courses in medical terminology, anatomy and physiology, legal aspects of health care, and introduction to health records). And Demonstrated Knowledge, Skills, and Abilities. In addition to the experience above, the candidate must demonstrate all of the following KSAs:(a) Ability to utilize health information technology and various office software products utilized in MRT (ROI) positions (e.g., the electronic health record, release of information systems, etc.).(b) Knowledge of health record documentation guidelines and processes for disclosing protected health information.(c) Ability to manage priorities and coordinate work in order to complete duties within required timeframes, and the ability to follow-up on pending issues.(d) Knowledge of policies, procedures, laws, and regulations governing privacy and release of information.(e) Ability to communicate with individuals from various backgrounds to obtain the desired effect or gaining information by establishing rapport. GS-6 Medical Records Technician (ROI)-Full Performance Level Experience. One year of creditable experience equivalent to the next lower grade level. And Demonstrated Knowledge, Skills, and Abilities. In addition to the experience above, the candidate must demonstrate all of the following KSAs:(a) Knowledge of the laws and regulations related to the authorization and disclosure of health information (e.g., Privacy Act, Freedom of Information Act, Health Insurance Portability and Accountability Act (HIPAA), and 38 U.S.C. § 7332, Confidentiality of Certain Medical Records).(b) Ability to apply health record documentation guidelines and processes to navigate efficiently through the paper and/or electronic health record to locate, assemble, and disclose protected health information.(c) Ability to apply policies, procedures, laws, and regulations governing privacy and release of information to process requests for release of information.(d) Ability to research and solve difficult questions related to release of health information in an accurate and timely manner. Reference: For more information on this qualification standard, please visit https://www.va.gov/ohrm/QualificationStandards/. The full performance level of this vacancy is GS-06. The actual grade at which an applicant may be selected for this vacancy is in the range of GS-04 to GS-06. Physical Requirements: You will be asked to participate in a pre-employment examination or evaluation as part of the pre-employment process for this position. Questions about physical demands or environmental factors may be addressed at the time of the evaluation or examination.

Education

IMPORTANT: A transcript must be submitted with your application if you are basing all or part of your qualifications on education.

Note: Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment. You can verify your education here: http://ope.ed.gov/accreditation/. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. For further information, visit: https://sites.ed.gov/international/recognition-of-foreign-qualifications/.

Contacts

• Address VA Nebraska-Western Iowa HCS - Omaha 4101 Woolworth Avenue Omaha, NE 68105 US
• Name: Justin Hillard
• Phone: (612) 842-9425
• Email: [email protected]