Level I Trauma Abstractor
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Job Description
Level I Trauma Abstractor at American Data Network supporting trauma data abstraction for healthcare clients. Reviewing clinical documentation and ensuring accuracy in data collection for trauma registries.
Responsibilities:
- Reviews patient medical records and abstracts data for the Trauma Registry.
- Applies registry specifications, definitions, inclusion and exclusion criteria, and abstraction guidelines accurately and consistently.
- Interprets clinical documentation and abstracts detailed injury and care data into the trauma registry database, including mechanism of injury, injury severity, clinical course, interventions, complications, and outcomes in accordance with Level I trauma standards.
- Enters accurate and complete data into assigned registry platforms, EHRs, vendor tools, or other data collection systems.
- Maintains a high level of abstraction accuracy, completeness, and attention to detail.
- Meets assigned productivity expectations, weekly progress goals, and internal and client deadlines.
- Participates in quality assurance activities, including feedback, correction, validation, and IRR reviews.
- Communicates professionally with account leads, team members, and client contacts when clarification is needed.
- Maintains strict confidentiality and complies with ADN, client, HIPAA, and data security requirements.
Requirements:
- At least 2 years of recent Level I Trauma Registry abstraction experience.
- Current trauma registry and coding education is required, including documentation of completion for the Trauma Registry Course, AAAM AIS Coding Course, and an ICD-10 coding course completed within the past five years.
- Ability to independently abstract Level I Trauma cases using registry specifications and clinical documentation.
- Strong understanding of healthcare quality reporting, registry abstraction, clinical documentation review, and medical record interpretation.
- Ability to work independently with minimal supervision while maintaining accuracy and meeting deadlines.
- Strong attention to detail, organization, documentation, and follow-through.
- Comfort working in multiple EHRs, registry platforms, vendor tools, and data collection systems as assigned.
- Excellent interpersonal and written communication skills.
- Contractors must have high-speed secure internet, a PC or laptop, and at least two monitors.
- Preferred: Experience using trauma applications, Level I Trauma reports, and/or other related data collection tools.
- Experience with IRR, QA review, audit validation, and/or abstraction accuracy review.
Benefits:
- Remote work options
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