Summary This position is located in the Health Information Management (HIM) section of the Business Office at the Bay Pines VA Healthcare System (BPVAHCS). MRTs HIT perform incomplete health record analysis. They review, analyze, abstract, maintain, extract, and compile information from the health record. MRTs HIT check for accuracy, completeness, and timeliness of the health record and monitor and report for regulatory compliance. Responsibilities Total Rewards of a Allied Health Professional Performs supervisory functions over Medical Records Technician (Health Information Technician) positions. Provides guidance and technical direction necessary for accomplishing the work of the unit. Provides guidance and recommendations to the Chief, HIM and Assistant, Chief HIM regarding staffing needs and shortages within the unit. Obtains needed information on decisions from the Chief, HIM or Assistant Chief, HIM on major issues and problems that arise. Duties and responsibilities include but are not limited to: Serves as subject matter expert in health record content and documentation requirements and administrative corrections to the health record, such as correcting note titles, designating correct signer/cosigner, ensuring notes are attached to the correct episode of care, etc. Responsible for performing quantitative and qualitative reviews of the health record documentation for ongoing regulatory reviews and deficiency analysis. Responsible for ensuring that all patient care data entered in the electronic health record (EHR) is accurate, timely, and completed. Adheres to established documentation requirements as outlined by The Joint Commission (TJC) regulations, Veterans Health Administration (VHA) guidelines, as well as medico-legal requirements. Provides effective audits and monitors for all areas of responsibility, ensuring accurate and timely data is processed by all employees. Reviews work accomplished and assesses quality, quantity, accuracy and timeliness of work produced by each employee. Ascertains problems encountered and takes corrective action. Monitors workload and productivity of staff, taking action where necessary to meet deadlines. Develops performance standards and conducts performance evaluations. Develops and conducts competency assessments. Ensures the work of staff is at an appropriate quality and productivity level. Responsible for carrying out established personnel functions and practices. Receives formal grievances, resolving those that can be resolved by the first level supervisor. Keeps employees informed about important aspects of personnel management programs. Implements provisions of EEO programs to ensure fair and equal treatment for all employees. Facilitates unit processes by working in collaboration with employees to ensure tasks are completed, good working relationships among staff members and with management are maintained, and team priorities and goals, needs, and achievements are coordinated with management. Distributes and balances workload and tasks among employees. Monitors the status and progress of work and makes adjustments in accordance with established priorities. Ensures the timely completion of work assigned to employees. Work Schedule: Monday through Friday from 8:00am to 4:30pm Compressed/Flexible: Not Authorized Recruitment Incentive (Sign-on Bonus): Not Authorized Permanent Change of Station (Relocation Assistance): Not Authorized Telework: Ad-hoc Only Virtual: This is not a virtual position. Functional Statement #: 21962F Permanent Change of Station (PCS): Not Authorized Requirements Conditions of Employment You must be a U.S. Citizen to apply for this job. Selective Service Registration is required for males born after 12/31/1959. Must be proficient in written and spoken English. Subject to background/security investigation. Selected applicants will be required to complete an online onboarding process. Acceptable form(s) of identification will be required to complete pre-employment requirements (https://www.uscis.gov/i-9-central/form-i-9-acceptable-documents). Effective May 7, 2025, driver's licenses or state-issued dentification cards that are not REAL ID compliant cannot be utilized as an acceptable form of identification for employment. Must pass pre-employment physical examination. Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP). Complete all application requirements detailed in the "Required Documents" section of this announcement. As a condition of employment for accepting this position, you will be required to serve a 1 or 2-year trial period during which we will evaluate your fitness and whether your continued employment advances the public interest. In determining if your employment advances the public interest, we may consider: your performance and conduct; the needs and interests of the agency; whether your continued employment would advance organizational goals of the agency or the Government; and whether your continued employment would advance the efficiency of the Federal service. Upon completion of your trial period, your employment will be terminated unless you receive certification, in writing, that your continued employment advances the public interest. Qualifications 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 HIT 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, anatomy, physiology, and a 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 HIT 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, 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 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. 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 U.S. Armed Forces or the U.S. Maritime Service, under close medical and professional supervision, may be substituted on a month-for-month basis for up to six months of experience, provided the training program included courses in anatomy, 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 for Supervisory Medical Records Technician (HIT), GS-08: Supervisory MRTs HIT at the GS-08 grade level provide the full range of supervisory duties, which include responsibility for determining staffing needs, assignment of work, performance evaluation, selection of staff, recommendations of awards and advancements, and disciplinary actions. They perform ongoing audits of staff for all areas of responsibility, and assign work to the staff at an appropriate quality and productivity level. They establish goals, train employees in the accomplishment of tasks or projects, and develop written policies, procedures, and guidelines. They serve as subject matter experts in health record content and documentation requirements. Supervisory MRTs HIT initiate various reports, analyze data, and work closely with clinical services to facilitate timeliness, completion, and accuracy of health record documentation. They monitor, maintain, and create statistical data to include incomplete and delinquent records, as well as quantitative and qualitative analysis findings, to produce reports for medical center management. Experience. One year of experience equivalent to the next lower grade level, GS-07. MRTs HIT at this level review, analyze, abstract, maintain, extract, and compile information from the health record independently with minimal supervision. They analyze health records for accuracy, completeness, timeliness, consistency, and compliance (e.g., scanned, uploaded, use of correct titles, linked to correct encounters, etc.) with HIM industry standards, policies, procedures, laws, regulations, and accreditation requirements. They also coordinate and/or perform health record review activities to satisfy external accreditation requirements and medical center performance measures. They communicate regularly with staff at various levels of the organization regarding delinquent health records, and notify individual clinical providers regarding incomplete medical records. MRTs HIT prepare complex reports, calculate department statistics, note the status of all incomplete/delinquent records, and submit reports to the appropriate administrative and clinical staff and committees/leadership to ensure deficiencies are resolved and completed appropriately. They serve as the expert resource for clinical staff and assist clinical providers with completion or correction of their health record documentation. They conduct the review of incomplete records for individuals clearing the facility. MRTs HIT coordinate the use of medical speech recognition/transcription and monitor, verify, troubleshoot, correct, and/or upload all transcription/medical speech recognition to maintain completeness and accuracy of health records. They serve as the technical expert in health record content and documentation requirements. Additionally, the GS-07 knowledge, skills, and abilities are the following: Ability to judge whether health records contain sufficient information for regulatory requirements, are acceptable as legal documents, are adequate for continuity of patient care, and support education and research needs. Ability to take appropriate actions if health record content is not adequate, accurate, timely, and/or reliable. Ability to communicate both orally and in writing with individuals or groups, to facilitate compliance with established policies and regulations. Skill in using appropriate software and computer applications to analyze and record documentation trends. Ability to apply qualitative and/or quantitative methods for assessment and improvement of health records. Ability to work independently and utilize problem-solving techniques in the accomplishment of work. Demonstrated Knowledge, Skills, and Abilities. In addition to the experience above, the candidate must demonstrate the following KSAs: Knowledge of operational tasks including record completion, discharge analysis, and abstracting health records, in accordance with facility accreditation, procedures, and regulatory policies. Ability to provide expert technical guidance in health record content and documentation requirements. Skill in utilizing various software and computer applications to generate and analyze various reports. Ability to coordinate and provide staff development and training. Ability to coordinate tasks and collaborate with individuals outside the work area and at higher organizational levels. Ability to provide the full range of supervisory duties, to include assignment of work, performance evaluation, selection of staff, and recommendation of awards, advancements, and disciplinary actions, when appropriate. NOTE: Be detailed in your resume as to how you meet these KSAs requirement; otherwise, we will not be able to award you credit for the experience/education/training you claim. Preferred Experience: 3 to 4 years of experience in Medical Records. 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-08. Physical Requirements: See VA Directive and Handbook 5019, Employee Occupational Health Service. Education Note: Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment. You can verify your education here: http://ope.ed.gov/accreditation/. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. For further information, visit: https://sites.ed.gov/international/recognition-of-foreign-qualifications/. Additional Information Receiving Service Credit for Earning Annual (Vacation) Leave: Federal Employees earn annual leave at a rate (4, 6 or 8 hours per pay period) which is based on the number of years they have served as a Federal employee. Selected applicants may qualify for credit toward annual leave accrual, based on prior work experience or military service experience. This credited service can be used in determining the rate at which they earn annual leave. Such credit must be requested and approved prior to the appointment date and is not guaranteed. During the application process you may have an option to opt-in to make your resume available to hiring managers in the agency who have similar positions. Opting in does not impact your application for this announcement, nor does it guarantee further consideration for additional positions. This job opportunity announcement may be used to fill additional vacancies. This position is in the Excepted Service and does not confer competitive status. VA encourages persons with disabilities to apply. The health-related positions in VA are covered by Title 38, and are not covered by the Schedule A excepted appointment authority. If you are unable to apply online or need an alternate method to submit documents, please reach out to the Agency Contact listed in this Job Opportunity Announcement. Under the Fair Chance to Compete Act, the Department of Veterans Affairs prohibits requesting an applicant's criminal history prior to accepting a tentative job offer. For more information about the Act and the complaint process, visit Human Resources and Administration/Operations, Security, and Preparedness (HRA/OSP) at The Fair Chance Act.
