Clinical Data Abstractor - #1336873

Position Summary

Abstract data from medical records or other tools using the appropriate guidelines to provide accurate and timely information for the department's customers. Knowledgeable of and performs the daily operational duties: Orders, obtains, tracks and returns charts/tools to meet productivity and timeliness requirements of the data collection. Perform data entry as directed and needed. Network with department customers to share expertise and to team build using various communication techniques.

• Job Relationships/Contacts:
  
  
  • Internal (Inside UHCMC)
  
  
  • Physicians
  
  
  • Nurses
  
  
  • Secretaries
  
  
  • Medical Records
• Purpose:
  
  
  • Share information to enhance efficiency and accuracy of the data capture process
• External (Outside UHC)
  
  
  • Physicians, Nurses, Medical Records at UHHS hospitals and facilities
  
  
  • JCAHO
  
  
  • Vendors
• Purpose: Share information to enhance efficiency and accuracy of the data capture process
  
  
  • Meet JCAHO requirements
  
  
  • Enhancement of software or tools for data collection

• Performs other duties as assigned.
• Complies with all policies and standards.
• For specific duties and responsibilities, refer to documentation provided by the department during orientation.
• Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.

Qualifications

Education

• High School Equivalent / GED . Required

• 2+ years experience in medial record abstraction/medical records background Required

• Computer skills include: word processing, spreadsheets, graphics and relational databases Required
• Excellent understanding of medical terminology and ICD-9 coding rules. Required
• Ability to communicate with many educational levels. Required
• Routine office equipment: pc, fax, printer, copier, etc. Required

• Standing Occasionally
• Walking Occasionally
• Sitting Constantly
• Lifting Rarely 20 lbs
• Carrying Rarely 20 lbs
• Pushing Rarely 20 lbs
• Pulling Rarely 20 lbs
• Climbing Rarely 20 lbs
• Balancing Rarely
• Stooping Rarely
• Kneeling Rarely
• Crouching Rarely
• Crawling Rarely
• Reaching Rarely
• Handling Occasionally
• Grasping Occasionally
• Feeling Rarely
• Talking Constantly
• Hearing Constantly
• Repetitive Motions Frequently
• Eye/Hand/Foot Coordination Frequently