Health Information Management Essay

1586 Words 7 Pages
Learning Experience Journal Entry – Director of Health Information Management and the Supervisor of Medical Records Coder
The purpose of this paper is to describe the role and functions of the Director of Health Information Management and the Supervisor of Medical Records Coder. I will provide a synopsis of what I observed and the activities I participated in during the learning experience. In addition I will provide an analysis of their primary roles and functions as they relate to nursing and patient services. Additionally, I will provide insights I have gained into the leadership behaviors or style as a result of my observations and interactions. Finally I will summarize my learning experience by comparing my observations to sources
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Synopsis: Director of Health Information Management
During this learning experience I had the opportunity to spend a few hours and observe the operations of our HIM. I met with Dee in her office where she shared with me her past experiences, challenges, and opportunities that have lead her to where she is now. One thing that stuck with me is the importance that knowledge one gains from experience is crucial to how we are as a leader in our profession. It is through the various experiences that one develops the expertise and skill needed to perform such a role. She reviewed with me the step by step process of obtaining a chart after discharge, assembling the chart (making sure all the parts of the chart are there and in order as well as every sheet of paper is bar-coded correctly), and scanning. This process is usually completed on the third shift so at the beginning of the following first shift the charts are ready for the coders to begin their process. At the same time Q&A and analyzing of the scanned chart with the hard copy is being done to examine for any missing parts. These deficiencies are brought to the units and physician’s attention for completion. Medical records are the keeper of the legal chart.

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