Medical Records Administrator Chief (CHIM)

Full Job Description

The John J Pershing VAMC is currently seeking a Chief of Health Information Management.

This position is located in the Health Information Management (HIM) Section of the Business Office Service at the John J. Pershing VA Medical Center.

Medical Records Administrators (MRAs) in VHA perform or supervise work concerned with the management of a health record program or the provision of services related to medical record administration/health information services.

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.

Education or Experience: Experience.

Three years of[ creditable] experience in the field of medical records that included the preparation, maintenance, and management of [health] records and health information systems [demonstrating a knowledge of medical terminology,] medical records [procedures, medical coding, or medical, administrative, and legal requirements of health care delivery] systems.

OR, Education. [Successful completion of a bachelor's degree or higher 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 management or health information technology.] OR, Experience/Education Combination.

Equivalent combinations of [creditable] experience and education that equals 100 percent may be used to meet basic requirements.

[For example, two years above high school from an accredited college or university, with 12 semester hours in health information technology/health information management, plus one year and six months of creditable experience that included the preparation, maintenance, and management of health records and health information systems meets an equivalent combination.

Certification: Persons hired or reassigned to MRA positions in the GS-0669 series in VHA must meet one of the following: (1) Coding Certification through AHIMA or AAPC. NOTE.

See paragraph 2a above for a detailed definition of Coding Certification. OR, (2) HIM Certification through AHIMA. NOTE. See paragraph 2d above for a detailed definition of HIM Certification.

OR, (3) Health Data Analyst Certification through AHIMA. NOTE. See paragraph 2c above for a detailed definition of Health Data Analyst Certification. NOTE.

HIMs Certification is required for all positions above the full performance level.

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: Medical Records Administrator (Chief (CHIM)),] GS-12 Preferred Experience: Extensive experience managing health information programs within the VA or similar healthcare systems.

Skilled in ensuring compliance with national HIM policies, Federal regulations, VA directives, and accrediting standards.

Proven ability to plan, direct, and evaluate program performance while maintaining accurate and complete health records. Provides expert guidance on documentation, privacy, and information exchange.

Strong leadership in staff management, performance oversight, and disciplinary processes. Exceptional communication, customer service, and problem-solving skills to support high-quality patient care.

(a) Experience.

One year of [creditable] experience equivalent to the next lower grade level that demonstrates the KSAs described at that level: Skill in performance and process improvement techniques to develop and implement new or improved solutions in health information management.

Ability to advise management and staff, at various levels, regarding health record documentation requirements and health information management practices based on current industry standards, policies, statues, laws, and regulations.

Ability to plan, justify, develop, evaluate, assess, monitor, and advise on current health information management processes and recommend changes in policies or procedures.

Ability to determine and evaluate compliance with legal, ethical, and regulatory guidelines and accrediting bodies, as they apply to health information management.

Ability to acquire, manage, analyze, interpret, and transform data into accurate, consistent, and meaningful information. AND (c) Demonstrated Knowledge, Skills, and Abilities.

Ability to determine and evaluate compliance with legal, ethical, and regulatory guidelines and accrediting bodies, as they apply to health information management.

Skill in evaluating, developing and implementing new policies, procedures, and programs.

Ability to provide program oversight, including advisory and technical expertise on a range of health information management practices and guidelines to staff at various levels.

Ability to develop and conduct training on health information management programs, policies, procedures, and performance improvement activities.

Ability to effectively procure and manage HIM resources (i.e. space, staffing, education, budget, etc.).

Ability to provide the full range of supervisory duties to include assignment of work; completing performance evaluations; selection of staff; and recommendation of awards, advancements, and disciplinary actions.

Customer service skills necessary to effectively communicate (written and verbal) and interact with all levels of hospital personnel, physicians, patients, and outside agencies.

Ability to deal effectively with sensitive and/or complex situations. Reference: For more information on this qualification standard, please visit https://www.va.gov/ohrm/QualificationStandards/.

The full performance level of this vacancy is GS12. Physical Requirements: The work is primarily sedentary. Light lifting and carrying of files/folders may be required.

Requires walking, sitting and standing for long periods of time. Major Duties:

Major Duties: This assignment serves as the Chief of Health Information Management (CHIM), which is the highest-level professional position at the facility, with responsibility for the management and direction of the health information management program.

Duties include but are not limited to: Provide technical advice, planning, and evaluation regarding health information management issues that impact the overall program on a regular and recurring basis.

Establish policies, procedures, responsibilities, and requirements for HIM related matters, such as health record documentation, coding and clinical documentation improvement, release of information, file room/scanning, records management, transcription and medical speech recognition, as well as the overall management of health information and Veterans health records.

Oversee implementation and adherence to HIM industry standards, policies, procedures, laws, regulations, and accrediting bodies.

Ensure that the facility is in compliance with applicable standards by completing HIM audits, developing healthcare data reports, and statistical information, for timely and accurate reporting.

Monitor HIM performance through dashboards, productivity standards, and benchmarking.

Participate in establishing and implementing strategic facility and HIM Department goals, controlling program activity costs, budgeting, procurement, and property management to achieve goals and improve processes.

Measure ongoing intradepartmental performance by establishing priorities, collecting data, monitoring and reporting outcomes, using valid and reliable techniques to analyze trends and variation, and taking appropriate action based on findings.

Responsible for all facets of health records management for the facility ensuring maintenance of complete, accurate, timely, clinically-pertinent, and readily-accessible patient health records, which contain sufficient recorded information to serve as a basis to plan patient care, support diagnoses, warrant treatment, measure outcomes, support education and facilitate performance improvement processes and legal requirements.

Serve as the key advisor to the Chief of Staff, Executive Management, and clinicians and is responsible for providing technical guidance on health information issues such as documentation requirements, liability issues, advance directives, informed consent, release of information, transcription/speech recognition, health information exchange, etc.

Recommends improvements in health record Complete internal quality assurance reviews to ensure employee performance and that work meets quality and quantity standards.

Responsible for leading the automation of all health information systems.

Conduct training programs in various areas health information management, such as medical terminology, health record documentation, release of information, medico-legal matters, speech recognition/transcription, scanning, medical coding, clinical documentation improvement, and health information exchange.

Has the full complement of HIM supervisory responsibility including coding, record completion, file room, scanning, release of information, and transcription and which consists of a mixture of HT38 (675 and 669) and T5 positions.

Perform the administrative and personnel management functions relative to staff supervised. Work Schedule: Monday-Friday 8:00 am - 4:30pm Telework: Adhoc Only as Needed.

Functional Statement #:0000 Highly Qualified Candidates may be selected to work Virtual (Employee works outside of original hiring duty station at VA-owned or leased space).