Kaiser Permanente ROI Specialist - KPNW in Clackamas, Oregon
Under indirect supervision, maintains confidentiality of protected health information (PHI). Reviews requests for health information. Abstracts case histories. Prepares medical records for use in legal proceedings. Supports compliance and Principles of Responsibility. Adheres to applicable federal and state laws and regulations, accreditation and licensing requirements, policies and procedures. Reports and/or resolves issues of non-compliance.
Meets compliance requirements by complying with all federal, state and local law, rules and regulations, as well as Kaiser Permanente-s policies and procedures for the release of health information by applying understanding of such law, and using judgment as to how best respond to a specific request based on the authorization provided for the release of PHI.
Accurately and proficiently analyze and interpret the health information to assure appropriate disclosure of health information to attorneys, insurance companies, outside providers of health care and others, as directed by the patient or as compelled by law or regulations.
Prepare health records in response to Subpoena Duces Tecum for court appearance or depositions.
Consult with health care providers to ascertain undocumented information such as patient data not entered into the health record by the provider.
Access various resources within the Kaiser Permanente system to locate health record information which may be found in secondary records, unfilled material, computerized data and dictated but not transcribed documentation in order to obtain time loss information, diagnosis, treatment, physical limitations or other required information requested by attorneys, insurance companies, outside providers and others.
Create summaries/abstracts of health information from paper and electronic health documentation.
Manipulate a variety of computer systems which are intricately designed programs in order to extract information regarding diagnosis, procedures, service utilization, length of stay, dates of service, ICD Codes, and provider identification.
Create / maintain documentation log of health information released so colleagues can clearly track what has been done.
Access Intranet and Internet to research laws and health related sources of information.
Compute costs for services provided and create lists for billing purposes.
Coordinate and track completion of physician forms and requests for narratives from attorneys, insurance companies, etc. May require communicating with physician regarding completion.
Performs other duties as assigned.
Four (4) years of experience in disclosure of Protected Health Information (PHI), with an emphasis on the legal aspects, in a healthcare setting or a recent graduate of an accredited Associate Degree Health Information Management (HIM) program and two (2) years of experience in a healthcare setting.
One (1) year customer service experience.
- High School Diploma or GED.
License, Certification, Registration
- Certification of medical terminology and abbreviations, current within two (2) years or final candidate(s) will need to complete the Kaiser Permanente medical terminology assessment with a minimum competency score of 84% or higher.
Ability to type minimum 40 wpm with above average accuracy.
Proficiency in the use of applicable computer software (e.g., MS Word, Excel, Outlook) and other work related tools (e.g., fax, copier, scanner, multi-line phone system, etc.).
Ability to understand and communicate Washington and Oregon laws and regulations that relate to release of information and disclosure of PHI and principles of confidentiality.
Familiarity with health record chart content, order, and ability to quickly scan large volumes of documents in paper form or online for sensitive information and requested documentation.
Ability to consistently meet or exceed department quality and productivity standards.
Strong organizational skills and ability to work independently and manage multiple priorities in a busy environment with frequent interruptions and time demands.
Demonstrated courtesy, helpfulness and respect in dealing with customers.
Good interpersonal skills with the ability to communicate effectively (both written and oral) with internal and external customers.
Willingness to work in a Labor/Management Partnership environment.
Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) preferred.
Comprehensive knowledge of anatomy and terminology preferred.
Basic knowledge of biology/anatomy/disease processes preferred.
Basic knowledge of laboratory tests and what they are ordered for preferred.
Basic knowledge of drugs and what they are prescribed for preferred.
Demonstrated accuracy, medical abstracting and time management skills preferred.
Good knowledge of Kaiser Permanente function and departments preferred.
Familiarity with Health Information Management policies and procedures (Privileged Information, Guidelines for Authorizations, Health Record Security, Health Record Documentation) preferred.
Comprehensive knowledge of Federal law and Health Insurance Portability and Accountability Act of 1996 preferred.
Strong knowledge of Oregon & Washington laws relating to health information preferred.
TITLE: ROI Specialist - KPNW
LOCATION: Clackamas, Oregon
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.
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