This position is located in the Health Information Management (HIM) section at the VA Maryland Healthcare System. The Medical Records Technician (ROI) reviews and processes request for patient protected health information (PHI). The MRT (ROI) also provides direct customer service to Veteran (or third party), by providing copies of the Veterans PHI, when a signed, written request is received, or upon the Veteran's valid authorization to a third party.
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 (ROI) must be proficient in spoken and written English, as required by 38 U.S.C. § 7403(f). Experience and Education 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, 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, 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). Grandfathering Provision. 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: 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. Employees who are appointed on a temporary basis prior to the effective date of the qualification standard may not have their temporary appointment extended, or be reappointed on a temporary or permanent basis, until they fully meet the basic requirements of the standard. Employees initially grandfathered into this occupation, who subsequently obtain additional education and/or licensure/certification/registration that meet all the basic requirements of this qualification standard, must maintain the required credentials as a condition of employment in the occupation. Grade Determinations: Medical Records Technician (ROI), GS-4: Experience or Education. None beyond basic requirements. Medical Records Technician (ROI), GS-5: Experience. One year of creditable experience equivalent to the next lower grade level; 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. 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. Medical Records Technician (ROI), GS-6 Experience. One year of creditable experience equivalent to the next lower grade level. Demonstrated Knowledge, Skills, and Abilities. 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-06. The actual grade at which an applicant may be selected for this vacancy is in the range of GS-04 to GS-06.
Major Duties, include but are not limited to: Provides direct customer service to the Veteran, their Personal Representative or third party by providing copies of the Veteran's health information Responsible for evaluating the adequacy of each completed authorization form Screens each request for information to determine urgency and ensure the most urgent requests are completed first using established priority systems Personally, greets Veterans/visitors and assists them in determining the nature of the request and whether the information requested can be released Applies public law, rules, regulations and exclusions governing confidentiality of the health record Processes all incoming requests to the facility for Release of Information along with information required by the VA regional Office through the Automated Medical Information Exchange (AMIE) Evaluates validity of each request Receives and directs callers and visitors, as well as giving out forms and assists with completion of those forms Searches records or files to compose responses Reviews paper and electronic health records (i.e., scanned notes, reports, special tests etc.) to identify material to be photocopied/printed/written to electronic media and released Composes detailed explanations in response to correspondence received, arranging information into logical sequence and appropriate format Resolves conflicting or inconsistent information found on initial requests to include resolving discrepancies, sorting out errors and reconstructing past transactions, cases or events, or finding alternative sources of information Replies to vague, incomplete, or ambiguous inquires by independently recognizing issues, topics, or problems Processes Social Security requests for health information using ROI software and downloads documents from the EHR, including scanned images, onto a secure Network Drive. Completes and processes routine releases 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 Work Schedule: Monday-Friday, 8:00am to 4:30pm Telework: Not available Virtual: This is not a virtual position. Functional Statement #: 512-25609-F, 512-25610-F, 512-25611-F Relocation/Recruitment Incentives: Not authorized Permanent Change of Station (PCS): Not authorized