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Health Information Management (HIM) Competency Framework

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The number of available resources are displayed in parentheses. Click on a competency to search for related learning resources then choose from the results. You may not need to learn every resource associated with a competency to achieve the competency.

Health Data Management

Health Data Structure, Content, and Standards

  • Apply policies and procedures to ensure the accuracy of health data. (19)
  • Collect and maintain health data (such as data elements, data sets, and databases). (17)
  • Conduct analysis to ensure that documentation in the health record supports the diagnosis and reflects the patient's progress, clinical findings, and discharge status. (14)
  • Verify timeliness, completeness, accuracy, and appropriateness of data and data sources for patient care, management, billing reports, registries, and/or databases. (18)
  • Healthcare Information Requirements and Standards

  • Apply policies and procedures to ensure organizational compliance with regulations and standards. (26)
  • Assist in preparing the organization for accreditation, licensing, and/or certification surveys. (8)
  • Maintain the accuracy and completeness of the patient record as defined by organizational policy and external regulations and standards. (19)
  • Monitor and apply organization-wide health record documentation guidelines. (26)
  • Clinical Classification Systems

  • Adhere to current regulations and established guidelines in code assignment. (78)
  • Apply diagnosis/procedure codes according to current nomenclature. (77)
  • Ensure accuracy of diagnostic/procedural groupings such as DRG, MSDRG, APC, and so on. (19)
  • Resolve discrepancies between coded data and supporting documentation. (39)
  • Use and maintain applications and processes to support other clinical classification and nomenclature systems (ex. DSM IV, SNOMED-CT). (15)
  • Use and maintain electronic applications and work processes to support clinical classification and coding. (41)
  • Validate coding accuracy using clinical information found in the health record. (46)
  • Hospital Coder on the Job Competencies

  • Communicate with physicians and other care providers to ensure appropriate documentation (2)
  • Health Data Management

    Reimbursement Methodologies

  • Apply policies and procedures for the use of clinical data required in reimbursement and prospective payment systems (PPS) in healthcare delivery. (16)
  • Apply policies and procedures to comply with the changing regulations among various payment systems for healthcare services such as Medicare, Medicaid, managed care, and so forth. (21)
  • Compile patient data and perform data quality reviews to validate code assignment and compliance with reporting requirements, such as outpatient prospective payment systems. (40)
  • Ensure accuracy of diagnostic/procedural groupings such as DRG, APC, and so on. (15)
  • Support accurate billing through coding, chargemaster, claims management, and bill reconciliation processes. (64)
  • Use established guidelines to comply with reimbursement and reporting requirements such as the National Correct Coding Initiative. (29)
  • Hospital Coder on the Job Competencies

  • Participate in compliance (fraud and abuse), HIPAA (Health Insurance Portability and Accountability Act of 1996), and other organization specific training (5)
  • Health Statistics, Biomedical Research, and Quality Management

    Healthcare Statistics and Research

  • Collect, maintain, and report data for clinical indices/databases/registries to meet specific organization needs such as medical research and disease registries. (13)
  • Collect, organize, and present data for quality management, utilization management, risk management, and other related studies. (15)
  • Comprehend basic descriptive, institutional, and healthcare vital statistics. (7)
  • Quality Management and Performance Improvement

  • Abstract and report data for facility-wide quality management and performance improvement programs. (17)
  • Analyze clinical data to identify trends that demonstrate quality, safety, and effectiveness of healthcare. (12)
  • Interpersonal Skills

    Develop the knowledge, skills, and understanding to make informed academic, social, personal, career, and interpersonal decision

  • Display high standards of ethical conduct and behaviors. (22)
  • Pursue appropriate learning activities contributing to lifelong professional growth. (26)
  • Maintain high standards for quality work and responsiveness in providing office administrative services. (22)
  • Better understand self (values, work ethic, attitudes, professional presence, personal wellness, self esteem).

  • Demonstrates behaviors that are consistent with standards for professional and ethical conduct. (44)
  • Function effectively as a member of a diverse team to accomplish common goals. (29)
  • Select career goals with thought and care, value work and the benefits it brings, and adjust to the inevitable changes in the working world.

  • Demonstrate a commitment to serving internal and external customers with quality outcomes. (15)
  • Apply new technical and business information/knowledge to practical use on the job. (12)
  • Research career advancement opportunities. (11)
  • Demonstrate rational approaches to decision making and problem solving.

  • Demonstrate through simulations and case studies continued rational approaches to solutions and remedies for office issues. (20)
  • Use correct oral and written grammar and develop strategies to avoid communication breakdown.

  • Conveys information clearly and effectively. (76)
  • Health Services Organization and Delivery

    Healthcare Delivery Systems

  • Apply current laws, accreditation, licensure, and certification standards related to health information initiatives from the national, state, local, and facility levels. (31)
  • Differentiate the roles of various providers and disciplines throughout the continuum of healthcare and respond to their information needs. (17)
  • Healthcare Privacy, Confidentiality, Legal, and Ethical Issues

  • Adhere to the legal and regulatory requirements related to the health information infrastructure. (43)
  • Apply and promote ethical standards of practice. (33)
  • Apply policies and procedures for access and disclosure of personal health information. (33)
  • Maintain user access logs/systems to track access to and disclosure of identifiable patient data. (26)
  • Release patient-specific data to authorized users. (27)
  • Information Technology & Systems

    Information and Communication Technologies

  • Apply policies and procedures to the use of networks, including intranet and Internet applications, to facilitate the electronic health record (EHR), personal health record (PHR), public health, and other administrative applications. (24)
  • Participate in the planning, design, selection, implementation, integration, testing, evaluation, and support for EHRs. (37)
  • Use common software applications such as spreadsheets, databases, word processing, graphics, presentation, e-mail, and so on in the execution of work processes. (293)
  • Use specialized software in the completion of HIM processes such as record tracking, release of information, coding, grouping, registries, billing, quality improvement, and imaging. (17)
  • Use technology, including hardware and software, to ensure data collection, storage, analysis, and reporting of information. (22)
  • Data, Information, and File Structures

  • Apply knowledge of database architecture and design (such as data dictionary) to meet departmental needs. (15)
  • Data Storage and Retrieval

  • Apply retention and destruction policies for health information. (11)
  • Query and generate reports to facilitate information retrieval using appropriate software. (8)
  • Use appropriate electronic or imaging technology for data/record storage. (10)
  • Data Security

  • Apply confidentiality and security measures to protect electronic health information. (26)
  • Apply departmental and organizational data and information system security policies. (16)
  • Protect data integrity and validity using software or hardware technology. (13)
  • Use and summarize data compiled from audit trails and data quality monitoring programs. (6)
  • Job Search/Employment

    Job Search and Advancement

  • Demonstrate job search skills required for employment. (361)
  • Demonstrate business awareness and workplace effectiveness. (22)
  • Organizational Resources

    Human Resources

  • Apply the fundamentals of team leadership. (36)
  • Comply with local, state, and federal labor regulations. (6)
  • Conduct orientation and training programs. (15)
  • Monitor and report staffing levels and productivity standards for health information functions. (17)
  • Participate in and work in teams and committees. (11)
  • Use tools and techniques to monitor, report, and improve processes. (19)
  • Financial and Resource Management

  • Contribute to work plans, policies, procedures, and resource requisitions in relation to job functions. (7)
  • Make recommendations for items to include in budgets and contracts. (6)
  • Monitor and order supplies needed for work processes. (4)
  • Monitor coding and revenue cycle processes. (5)
  • Recommend cost-saving and efficient means of achieving work processes and goals. (9)
  • Other

    Anatomy & Physiology

  • Structure and function of the human body (725)
  • Medical Terminology

  • Medical Prefixes, suffixes, root words, combining forms, and common terminology used by body system. (68)
  • Pathophysiology

  • Diseases processes including signs and symptoms, diagnosis, treatment, and prognosis. (8)
  • Pharmacotherapy

  • Common prescription and over the counter medications by body system. (17)