Trauma Registrar

Job Description

Job Description

Trauma Registrar

Job Type: Temporary (3-Month Assignment)
Pay Rate: $40-43/hour
Location: Valhalla, NY | On-site (Monday-Friday, 7:00am-3:30pm)

Job Overview

Madison Approach Staffing is recruiting for a Trauma Registrar for our client's Trauma Department. Our client is a large healthcare organization seeking an experienced medical record abstractor to collect, code, and report data regarding patients with traumatic injuries for the New York State Trauma Registry. This role reviews medical records, identifies reportable trauma cases, abstracts clinical information, and enters data into the Trauma Registry database according to program guidelines. The ideal candidate has 3+ years of hospital coding experience, strong knowledge of ICD coding and medical terminology, and ability to accurately abstract complex clinical information from medical records.

Key Responsibilities

• Review medical records to collect information related to trauma patients
• Identify patient records that meet criteria for inclusion in NY State Trauma Registry using ICD diagnosis and Registry criteria
• Read and interpret medical record components including physician documentation, radiology reports, laboratory reports, and treatment information
• Abstract and code patient information for entry into Trauma Registry Database
• Prepare exclusion reports for Trauma Registry when appropriate
• Research and obtain additional information not in medical records by contacting physicians or other institutions
• Obtain follow-up information for database entry
• Maintain trauma data collection system consistent with regulatory and procedural policies
• Perform quality control activities to ensure accuracy of data
• Run, compile, and distribute routine and specialized reports for hospital administration and staff
• Participate in all functions related to Trauma Registry as required

Required Skills & Experience

• Experience: 3+ years in hospital or healthcare facility where primary function was obtaining, coding, and reporting information using ICD-9, ICD-10, CPT, or HCPCS codes
• Education: High school diploma or equivalency required; Associate's or Bachelor's degree preferred
• Medical Coding: Strong knowledge of ICD codes; ability to read, understand, and apply appropriate guidelines for trauma abstracting
• Medical Terminology: Knowledge of medical terminology and ability to understand medical records
• Trauma Registry Knowledge: Knowledge and understanding of New York State Trauma Registry guidelines for trauma abstracting
• Abstracting Skills: Ability to accurately abstract and stage information from various components of patient medical records
• Coding Skills: Ability to understand and code medical records using standard coding systems
• Attention to Detail: Strong attention to detail and commitment to data accuracy and quality control
• Communication: Ability to communicate with clinical staff and research additional information as needed

Required Certifications

• CSTR (Certified Specialist in Trauma Registry) – Must be obtained within 2 years of employment
• CAISS (Certified Abstractor in ICD-9/ICD-10 Severity Staging) – Must be obtained within 2 years of employment

Preferred Skills & Experience

• CPC (Certified Professional Coder) certification
• Prior trauma registry experience
• Experience with medical record abstracting in acute care setting
• Familiarity with electronic health records (EHR) systems
• Experience with quality assurance and data validation
• Prior experience with healthcare reporting and analytics