This is administrative medical records library work directing and coordinating the activities of the medical records units of multiple health services facilities. Work involves establishing and interpreting policies and procedures on the maintenance of medical case histories. An employee in this class is responsible for assuring compliance with established governmental and professional standards and regulations.

Work is performed under the direction of an administrative superior. Contact with health facility administrators, hospital officials, legal personages, and health insurers is a significant aspect of the work.

• Directs, through subordinate supervisors, the activities of staffs working at various health centers engaged in reviewing medical case histories, coding diseases, maintaining case master files and interpreting and editing patient encounter forms.
• Directs, through subordinate supervisors, activities such as filing, withdrawing and issuing charts; reviews, periodically, on a spot check basis, completed assignments for technical accuracy and makes suggestions on improving methods for performing tasks; provides directions on the preparation and arrangement of medical information, the use of medical terminology, and the nomenclature and classification of disease.
• Studies records system with a view to improving such operations as analyzing, coding, indexing, and filing a large volume of medical records; develops system of medical record keeping, determines changes to be made and implements, upon the approval of superiors, new procedures.
• Establishes techniques used in the review of medical case histories, and develops and implements procedures such as chart issuance and storage.
• Functions as a liaison between third party insurers and health facilities; reviews progress of contracts between health facilities and hospitals on technical matters; monitors requests for reimbursements to assure proper compliance.
• Attends meetings with departmental administrators for purposes of improving record-keeping and forms control; attends meetings of technical associations to learn, recommend and discuss new methods and techniques.
• Provides professional groups and public with information, concerning services delivered by the health facilities.
• Reviews performance of subordinate supervisors to insure compliance with established procedures; participates in the annual performance evaluations of subordinate supervisors.
• Performs related work as required.

KNOWLEDGE OF:

• medical record-keeping principles and practices including international classification of diseases.
• medical and anatomical terminology and etiology required for the proper classification, maintenance, and custody of medical case records.
• the legal and city policy requirements relating to the maintenance and release of information from medical records.
• pertinent federal, state and local regulations governing medical records and reports of medical care, statistics and diseases.

ABILITY TO:

• develop plans and procedures to improve the maintenance of medical records.
• plan, assign, and supervise the specialized and standardized work of subordinates engaged in the classification, filing, and maintenance of medical records and to instruct new employees in standardized and specialized clerical work.
• perform highly complex work in abstracting, analyzing, coding, and indexing of medical records.
• prepare complex reports based on the analysis of medical records.
• establish and maintain effective working relationships with departmental personnel, officials of governmental agencies and outside professional and legal representatives.
• present ideas effectively, both orally and in writing.

• Completion of a bachelor's degree program at an accredited college or university, supplemented by completion of a two-year course for medical records librarians.
• Four years of experience classifying, indexing, coding and abstracting medical records including two years supervising a staff engaged in such activities.

PHYSICAL AND MEDICAL REQUIREMENTS

• Ability to meet approved minimal and physical medical standards.

PAY RANGE: EP18
Class Established: 6/1983

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