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HIM Patient Identity Specialist

Job Description

Independently performs specialized or advanced health information activities necessary to organize, maintain, and use electronic patient health records. Activities required include research, analysis and compilation of findings into summarized reports that will be shared within and external to the Health Information Management Department.

  • Positions at this level have high customer service, strong analytic and problem solving skills, require interpretation and explanation of policy and external requirements related to, privacy, release of information, positive patient identity, and other department and organization-wide functions. Specific job responsibilities are based on the service unit within Health Information Management assigned. Expert computer skills to navigate and query multiple electronic record systems.
  • Release of Information: regular interaction required with patients, attorneys, governmental agencies, providers of health care, insurance companies, auditing agencies, and researchers. Detailed working knowledge and ability to apply HIPAA rules, North Carolina General Statutes, and other State and Federal laws regarding patient privacy.
  • Patient Identity Management: regular interactions required with patients, attorneys, insurance companies, providers of healthcare and governmental agencies. Detailed working knowledge and ability to apply State and Federal laws regarding positive patient identification, identity theft, vital records regulations, Joint Commission requirements, and CMS guidelines and rules.

Duties and Responsibilities

  • Reviews request for medical records to identify dates of service, provider and specific clinical documents requested. Works extensively in the electronic health record and de-centralized electronic databases to locate specific clinical documents for the purpose of fulfilling a request.
  • Reviews patient authorizations to validate HIPAA required elements and validate legal authority of requestor. Reviews NC and Out of State Subpoenas and Court Orders to determine if valid and returns to requestor if deemed invalid.
  • Coordinates visits from Health Plan Reviewers and Research Monitors through provision of electronic medical records, assignment of passwords and deactivates passwords at conclusion of visit. Assists reviewer in locating specific documents as needed.
  • Reviews requests for patient amendments, locates disputed documents in the electronic health record and notifies provider of patient request for amendment. Tracks amendment request to ensure patient is notified of outcome within HIPAA required time frame.
  • Obtains Itemized Statements from PRMO Self Pay and uses to calculate lien balances and generate Attorney Lien letter and forwards Itemized Statement to requestor as needed.
  • Obtains provider approval to release psychiatric encounter records when requested by patient and seeks provider approval to release records for minor patients ages 12-17 to parent to comply with additional privacy protections under NC Statute and Federal Law.
  • Uses knowledge of HIPAA and NC Statute to determine if requestor is invoiced for medical record copies and generates an invoice for billable requestors.
  • Accompanies original health records to court and location of scheduled depositions when required. Testifies in court and depositions as to the authenticity of health records containing PHI.


PATIENT IDENTITY MANAGEMENT JOB RESPONSIBILITIES

  • Track, monitor and validate patient overlays that occur during patient registration and scheduling activities. Analyze and trend data for feedback to appropriate department. Notifies compliance and affected departments of incorrect documentation location.
  • Researches through comparison of demographic and clinical information and resolves patient identification problems referred by external departments or patients for fraudulent identity use, such as identity theft.
  • Performs concurrent and retrospective contact moves. Analyzes the content of health record document, coordinates with responsible providers, clinicians, and ancillary department participating in the patient's care for record correction requirements to resolution.
  • Leads clinical, ancillary and financial staff to assist in resolving overlay issues of multiple patient information in one medical record to resolve overlay within 24 hours of discovery of overlay.
  • Participates in 24-hour on-call rotation.
  • Maintains enterprise master patient index integrity medical record number merges, un-merges and medical record number assignments electronically. Performs name and demographic changes with supporting documentation.
  • Works with management to compile and review reports of duplicate numbers, overlays, contact moves errors and identifies patterns related to user and type of error.

Minimum Qualifications

Education
Associate’s degree in a health information management required.

Experience
Two years’ experience in health care preferred

Licensure
RHIT or eligible, required.

Knowledge, Skills, and Abilities:

  • Good organizational skills, excellent investigative/analytic skills with detail orientation, and strong follow-through capabilities.
  • Excellent verbal and written communication skills in order to effectively problem solve, develop working relationships and assist system users.
  • Must be able to meet deadlines, work independently, set priorities and maintain confidentiality.
  • Ability to work calmly and efficiently in high-pressure situations. Intermediate knowledge of human anatomy and physiology and medical terminology highly preferred.
  • Intermediate to Expert skills using Windows-based software, familiarity with information technology hardware and software in a local and wide area network environment.
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