Medical Records Technician - Release Of Information

Full Job Description

The MRT-ROI reviews, processes & indexes requests for protected health information (PHI).

Provides direct customer service to Veterans (or third party), by providing copies of the Veteran's PHI, when a signed, written request is received.

Must possess expertise in all applicable Federal laws, rules, & regulations regarding release of health information & disclose health information in accordance with all laws & regulations governing authorization & disclosure of health information.

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.

English Language Proficiency: MRTs (ROI) must be proficient in spoken and written English, as required by 38 U.S.C. § 7403(f).

Experience and/or Education: 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 Have an associate'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 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 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: 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.

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.

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 MRT (ROI):Experience or Education: None beyond basic requirements.

GS 5 MRT (ROI): Experience: One year of creditable experience equivalent to the next lower grade level (GS4) 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).

Demonstrated Knowledge, Skills, and Abilities (KSAs): In addition to the experience above, the candidate must demonstrate all of the following KSAs: 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.).

Knowledge of health record documentation guidelines and processes for disclosing protected health information.

Ability to manage priorities and coordinate work in order to complete duties within required timeframes, and the ability to follow-up on pending issues.

Knowledge of policies, procedures, laws, and regulations governing privacy and release of information.

Ability to communicate with individuals from various backgrounds to obtain the desired effect or gaining information by establishing rapport.

GS 6 MRT (ROI):Experience: One year of creditable experience equivalent to the next lower grade level GS5.

Demonstrated Knowledge, Skills, and Abilities (KSAs): In addition to the experience above, the candidate must demonstrate all of the following KSAs: 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).

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.

Ability to apply policies, procedures, laws, and regulations governing privacy and release of information to process requests for release of information.

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 6.

The actual grade at which an applicant may be selected for this vacancy is in the range of GS 4 to GS 6. Physical Requirements: See VA Directive and Handbook 5019, Employee Occupational Health Service.

Major Duties:

Total Rewards of a Allied Health Professional The duties in this position are primarily advisory and technical in nature.

Responsible for evaluating the adequacy of each completed authorization form Screen each request for information to determine urgency and assure that most urgent requests are completed first using established priority systems Greet veterans/visitors, assists them in determining the exact nature of the request and whether the information requested can be released Apply public laws, rules, regulations and exclusions governing confidentiality of the health record Process all incoming requests to the facility for ROI along with information required by the VA Regional Office through the Automated Medical Information Exchange (AMIE) or the electronic health record (EHR) Evaluate the validity of each request & determine which information is to be released in compliance with existing laws Receive and/or gives out forms and assists visitors and/or callers with the completion of forms or documents Provide advisory and technical assistance to patients, administrative staff, and professional staff regarding release of information Search records or files to compose responses, including electronic searches to retrieve and summarize hard-to-locate data Compose responses to routine requests for release of patient information Select and compile information from health records and prepares correspondence, typically using standard form or standard formats for letters Ensure the information released is limited to what is specifically authorized and to the person or agency designated to receive it Compose detailed explanations in response to correspondence received Resolve conflicting or inconsistent information found on initial requests Reply to vague, incomplete, or ambiguous inquires by independently recognizing issues, topics, or problems Process Social Security requests for health information using ROI software Complete and process routine release 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 Receive, index, and assign appropriate document type to health and administrative information, as assigned, for incorporation into the correct patient's record in the computerized patient records system (CPRS) Receive incoming documentation from professional, technical, and administrative personnel in all levels of operating elements Ensure all necessary health/administrative information is integrated into CPRS through Imaging software Perform other duties as required or assigned and must be flexible to undertake a variety of miscellaneous duties as assigned by the Supervisor Work Schedule: Monday-Friday 7AM to 3:30PM or 8AM to 4:30PM Recruitment Incentive (Sign-on Bonus): Not Authorized Permanent Change of Station (Relocation Assistance): Not Authorized Pay: Competitive salary and regular salary increases.

When setting pay, a higher step rate of the appropriate grade may be determined after consideration of higher or unique qualifications or special needs of the VA (Above Minimum Rate of the Grade).

Paid Time Off: 37-50 days of annual paid time offer per year (13-26 days of annual leave, 13 days of sick leave, 11 paid Federal holidays per year) Selected applicants may qualify for credit toward annual leave accrual, based on prior [work experience] or military service experience.

Parental Leave: After 12 months of employment, up to 12 weeks of paid parental leave in connection with the birth, adoption, or foster care placement of a child.

Child Care Subsidy: After 60 days of employment, full time employees with a total family income below $144,000 may be eligible for a childcare subsidy up to 25% of total eligible childcare costs for eligible children up to the monthly maximum of $416.66.

Retirement: Traditional federal pension (5 years vesting) and federal 401K with up to 5% in contributions by VA Insurance: Federal health/vision/dental/term life/long-term care (many federal insurance programs can be carried into retirement) Telework: Not Authorized Virtual: This is not a virtual position Functional Statement #: 56307A, 56308A, 56309A Permanent Change of Station (PCS): Not Authorized