MEDICAL RECORDS TECH (ROI- Legal)

Description:

This position is located in the Health Information Management (HIM) section in the Clinical Operations Service at the Tennessee Valley Healthcare System. The MRT (ROI) reviews and processes requests for patient protected health information (PHI). The MRT (ROI) also provides direct customer service to the Veteran (or third party), by providing copies of the Veteran's PHI, when a signed, written request is received, or upon the Veteran's valid authorization to a third party.

Requirements:

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.
• English Language Proficiency . MRTs (Coder) must be proficient in spoken and written English as required by 38 U.S.C. § 7403(f).
• Physical Requirements . See VA Directive and Handbook 5019, Employee Occupational Health Services.
• Experience and Education
  • (1) 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
  • (2) Education . 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
  • (3) 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.

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).
All persons employed in VHA as a MRT (ROI) on the effective date of this qualification standard are considered to have met all qualification requirements for the grade held, including positive education and licensure/certification/ registration that are part of the basic requirements of the occupation. Employees who do not meet all the basic requirements in this standard, but who met the qualifications applicable to the position at the time they were appointed to it, the following provisions apply:

• (1) Such employees in an occupation that does not require a licensure/certification/registration may be reassigned, promoted, or demoted within the occupation, but will not be promoted beyond the journey level or placed in supervisory or managerial positions.

Creditable Experience . Experience is only creditable if it is paid or non-paid employment directly related to the position to be filled, or in a related field such as medical support assistants, ward clerks, health record file room/scanning technicians, incomplete health record analysis, medical coding, or other positions that included knowledge of the content and use of health records. To be creditable, the candidate's experience must have demonstrated the use of knowledge, skills, and abilities associated with current release of information practice. This experience does not have to be in federal service, however, non-federal experience must be equivalent to the GS-06 grade level.

In addition to the basic requirements, the below qualification requirements must be met at the grade in which you are applying.

Grade Determinations : GS-07, Medical Records Technician (Release of Information-Legal)

1. Experience . One year of creditable experience equivalent to the next lower grade level.
2. Assignment . For all assignments above the journey level, the higher-level duties must consist of significant scope, complexity (difficulty), range of variety, and be performed by the incumbent at least 25% of the time. MRTs at this grade level will serve as the sole point of contact, and accurately process and timely respond to complex medical legal requests, including, but not limited to, subpoenas, depositions, testimony, tortfeasor (Third Party Liability), Workers' Compensation, Labor and Industries, and court orders for information from attorneys, courts, local law enforcement agencies, public defenders, or insurance agencies. They serve as a liaison to Regional Counsels and U.S. Attorney's offices, for trial cases. They review and analyze requests to ascertain the type of case to be developed. MRTs (ROI -Legal) ensure all disclosures are made in compliance with existing policies, procedures, guidelines, laws, and regulations. They ensure that information released is limited to what is specifically authorized and to the person or agency designated to receive it. They maintain the accounting of disclosures for all leg al cases. MRTs (ROI-Legal) compile the legal health record and provide advisory and technical assistance to patients and internal and external stakeholders pertaining to medical legal requests. They extensively research and resolve conflicting or inconsistent information related to complex medical legal requests.
3. Demonstrated Knowledge, Skills, and Abilities . In addition to the experience above, the candidate must demonstrate all of the following KSAs:
   1. Knowledge of the laws and regulations related to the authorization and disclosure of health information.
   2. Ability to apply laws and regulations related to the disclosure of health information (e.g., Privacy Act, Freedom of Information Act, HIPAA, and 38 U.S.C.§ 7332, Confidentiality of Certain Medical Records).
   3. Ability to investigate the contents of paper and electronic health records and systems that contain health information to compile the legal health record based on existing standards and requirements.

References: VA Handbook 5005/123, Part II, Appendix G58, dated 12/10/2019

Physical Requirements: The work is primarily sedentary. There is walking, bending and reaching required such as for filing or locating material, and carrying items such as reports, documents, and supplies. Entering data and word processing on a personal computer may result in physical problems from the effects of repetitive motion and eyestrain. A portion of each day is spent in the laboratory, sorting and preparing samples for testing, which involves periods of standing.