# Business Office Staff

Contents

[6.1 Business Office Staff Descriptions
6-2](#business-office-staff-descriptions)

[6.1.1 Receptionist 6-2](#receptionist)

[6.1.2 Admitting Clerk 6-2](#admitting-clerk)

[6.1.3 Check-in Clerk 6-3](#check-in-clerk)

[6.1.4 Registration Clerk 6-3](#registration-clerk)

[6.1.5 Appointment Clerk 6-4](#appointment-clerk)

[6.1.6 Patient Benefit Coordinator 6-4](#patient-benefit-coordinator)

[6.1.7 Biller 6-5](#biller)

[6.1.8 Accounts Receivable 6-6](#accounts-receivable)

[6.1.9 Compliance Officer 6-7](#compliance-officer)

[6.2 Performance Appraisal and Productivity
6-8](#performance-appraisal-and-productivity)

[6.2.1 Progressive Performance Evaluations
6-9](#progressive-performance-evaluations)

[6.2.2 Performance Appraisal Traps and Pitfalls
6-10](#performance-appraisal-traps-and-pitfalls)

[6.3 Examples of Performance Evaluation Criteria
6-12](#examples-of-performance-evaluation-criteria)

[6.3.1 Check-in Clerk Performance Evaluation Criteria
6-12](#check-in-clerk-performance-evaluation-criteria)

[6.3.2 Admitting Clerk Performance Evaluation Criteria
6-13](#admitting-clerk-performance-evaluation-criteria)

[6.3.3 Registration Staff Performance Evaluation Criteria
6-14](#registration-staff-performance-evaluation-criteria)

[6.3.4 Patient Benefit Coordinator Performance Evaluation Criteria
6-15](#patient-benefit-coordinator-performance-evaluation-criteria)

[6.3.5 Biller Performance Evaluation Criteria
6-15](#biller-performance-evaluation-criteria)

[6.3.6 Accounts Receivable Performance Evaluation Criteria
6-16](#accounts-receivable-performance-evaluation-criteria)

## Business Office Staff Descriptions

The following sections provide a list of duties and qualifications for
key Business Office personnel.

### Receptionist

+-----------+----------------------------------------------------------+
| Duties    | -   Addresses patients, visitors, and co-workers in a    |
|           |     pleasant and respectful manner; displays courtesy at |
|           |     all times.                                           |
|           |                                                          |
|           | -   Directs patient to appropriate person or clinic.     |
|           |                                                          |
|           | -   Answers questions.                                   |
|           |                                                          |
|           | -   Checks and/or validates the patient's schedule on    |
|           |     the system.                                          |
|           |                                                          |
|           | -   Contacts departments or staff, if needed.            |
|           |                                                          |
|           | -   Works on various reports in between activities, as   |
|           |     assigned by supervisor.                              |
|           |                                                          |
|           | -   Answers telephone calls to facility and directs      |
|           |     calls appropriately.                                 |
+-----------+----------------------------------------------------------+
| Qualif    | -   High school graduate                                 |
| ications: |                                                          |
|           | -   Personal and friendly patient relations              |
+-----------+----------------------------------------------------------+

### Admitting Clerk

+-----------+----------------------------------------------------------+
| Duties    | -   Relates well with facility, providers, and patients. |
|           |                                                          |
|           | -   Complies with the facility's general policies and    |
|           |     procedures.                                          |
|           |                                                          |
|           | -   Schedules patient for admission to the facility.     |
|           |                                                          |
|           | -   Verifies insurance prior to admission.               |
|           |                                                          |
|           | -   Interviews patient upon arrival at facility.         |
|           |                                                          |
|           | -   Contacts elective patients to confirm admitting      |
|           |     information, assigns appointment time and reminds    |
|           |     patient to bring insurance cards.                    |
|           |                                                          |
|           | -   Enters complete and accurate information on the      |
|           |     admission record prior to patient's arrival.         |
|           |                                                          |
|           | -   Obtains signatures for medical and financial         |
|           |     documents.                                           |
|           |                                                          |
|           | -   Obtains any prior authorization.                     |
|           |                                                          |
|           | -   Assures preadmission testing is completed and is     |
|           |     received by the facility.                            |
|           |                                                          |
|           | -   Retains test results, provider records and medical   |
|           |     and financial consents until time of admission.      |
|           |                                                          |
|           | -   Admits patients.                                     |
|           |                                                          |
|           | -   Enters complete and accurate information on the      |
|           |     admission record.                                    |
|           |                                                          |
|           | -   Obtains signatures on medical and financial          |
|           |     documents.                                           |
|           |                                                          |
|           | -   Prepares and places identification bands on          |
|           |     patients.                                            |
|           |                                                          |
|           | -   Records and deposits patient valuables properly.     |
|           |                                                          |
|           | -   Contacts nursing station before the patient is       |
|           |     escorted to the assigned room.                       |
|           |                                                          |
|           | -   Either escorts "walking elective patients" or places |
|           |     non-elective patients in wheelchairs and takes them  |
|           |     to the nursing station.                              |
|           |                                                          |
|           | -   Complies with facility-wide policies and procedures, |
|           |     safety and disaster plans and the quality assurance  |
|           |     program.                                             |
|           |                                                          |
|           | -   Attends department meetings to present/exchange      |
|           |     pertinent information                                |
|           |                                                          |
|           | -   Prepares reports on admissions.                      |
+-----------+----------------------------------------------------------+
| Qualif    | -   High school graduate                                 |
| ications: |                                                          |
|           | -   Hospital experience is preferred                     |
|           |                                                          |
|           | -   Familiarity with computer systems                    |
|           |                                                          |
|           | -   Positive and cooperative outlook                     |
+-----------+----------------------------------------------------------+

### Check-in Clerk

1.  This function must occur at the point of check-in.

-   Checks patient in the Patient Information Management System (PIMS).

-   Verify eligibility.

-   Identify the order of billing/coordination of benefits based on
    reason for visit or clinic type.

-   Accept payment from non-beneficiaries, if applicable.

The check-in clerk can be under the supervision of a department other
than the Business Office, or the position can be combined with
Registration based on the patient process.

### Registration Clerk

+-----------+----------------------------------------------------------+
| Duties    | -   Greet and register patients.                         |
|           |                                                          |
|           | -   Verify insurance benefits and eligibility within the |
|           |     timeframe set by the facility.                       |
|           |                                                          |
|           | For Medicare and Medicaid: verifies eligibility          |
|           | electronically.                                          |
|           |                                                          |
|           | For private or dental insurance: initiates telephone     |
|           | calls to determine\                                      |
|           | eligibility, certification requirements, and any benefit |
|           | limitations.                                             |
|           |                                                          |
|           | -   Makes initial determination on which insurance is    |
|           |     primary, secondary.                                  |
|           |                                                          |
|           | -   Copies new insurance cards.                          |
|           |                                                          |
|           | -   Makes new patient chart.                             |
|           |                                                          |
|           | -   Has patient sign any required forms.                 |
|           |                                                          |
|           | -   Collects any payments (non-beneficiary only).        |
|           |                                                          |
|           | -   Checks patient in (scheduled patient).               |
|           |                                                          |
|           | -   Updates insurance and demographic information (every |
|           |     30 days) in RPMS.                                    |
|           |                                                          |
|           | -   Pulls patient's medical record (walk-in).            |
|           |                                                          |
|           | -   Enters all information into the RPMS Patient         |
|           |     Registration application and free text screen.       |
|           |                                                          |
|           | -   Notifies staff that patient has arrived.             |
|           |                                                          |
|           | -   Refers potentially eligible Medicare and Medicaid    |
|           |     patients to Patient Benefit Coordinator.             |
|           |                                                          |
|           | -   Continues to stay informed of any changes in         |
|           |     regulations or statutes that could impact            |
|           |     reimbursement.                                       |
+-----------+----------------------------------------------------------+
| Qualif    | -   High school diploma                                  |
| ications: |                                                          |
|           | -   Exceptional customer service                         |
|           |                                                          |
|           | -   Attention to detail                                  |
|           |                                                          |
|           | -   Familiarity with and understanding of insurance      |
|           |                                                          |
|           | -   Proficiency with computer systems                    |
+-----------+----------------------------------------------------------+

### Appointment Clerk

+-----------+----------------------------------------------------------+
| Duties    | -   Schedules and coordinates patient appointments.      |
|           |                                                          |
|           | -   Updates provider's schedule into scheduling system.  |
|           |                                                          |
|           | -   Mails reminder appointment letters to patients or    |
|           |     calls to verify appointment.                         |
|           |                                                          |
|           | -   Cancels and reschedules appointments or makes        |
|           |     changes to provider's schedule.                      |
|           |                                                          |
|           | -   Contact patients to reschedule appointment.          |
|           |                                                          |
|           | -   Updates system with no show patients.                |
|           |                                                          |
|           | -   Prepares monthly report of scheduled, walk-in and no |
|           |     show patients.                                       |
+-----------+----------------------------------------------------------+
| Qualif    | -   High school graduate                                 |
| ications: |                                                          |
|           | -   Familiarity with computer systems                    |
|           |                                                          |
|           | -   Exceptional customer service                         |
+-----------+----------------------------------------------------------+

### Patient Benefit Coordinator

+-----------+----------------------------------------------------------+
| Duties    | -   Determines if any other third party alternate        |
|           |     resources are available to patient.                  |
|           |                                                          |
|           | -   Coordinates with registration to follow up on        |
|           |     potential Medicare and Medicaid patients.            |
|           |                                                          |
|           | -   Educates registration staff on basics of alternate   |
|           |     resource programs.                                   |
|           |                                                          |
|           | -   Evaluates patient eligibility for the state Medicaid |
|           |     program.                                             |
|           |                                                          |
|           | -   Explains the benefits and values of the Medicaid     |
|           |     program to the patient.                              |
|           |                                                          |
|           | -   Assists patient in completing the Medicaid           |
|           |     application.                                         |
|           |                                                          |
|           | -   Reminds patient of information needed by the state   |
|           |     agency.                                              |
|           |                                                          |
|           | -   Follows up with state agency regarding eligibility.  |
|           |                                                          |
|           | -   Maintains a log of all patients to include notes and |
|           |     status.                                              |
|           |                                                          |
|           | -   Updates the RPMS system on conversations and updates |
|           |     on patient eligibility.                              |
|           |                                                          |
|           | -   Sends a notice to the billing office with the new    |
|           |     Medicaid number.                                     |
|           |                                                          |
|           | -   Evaluates patient eligibility for the Medicare       |
|           |     pharmacy program.                                    |
|           |                                                          |
|           | -   Explains the benefits and values of the Medicare     |
|           |     pharmacy program to the patient.                     |
|           |                                                          |
|           | -   Assists patient with application for pharmacy        |
|           |     program.                                             |
|           |                                                          |
|           | -   Determines when patient becomes eligible and updates |
|           |     RPMS system.                                         |
|           |                                                          |
|           | -   Prepares monthly reports of activity for             |
|           |     Administration:                                      |
|           |                                                          |
|           | Number of patients identified potentially eligible       |
|           |                                                          |
|           | Number of patients interviewed                           |
|           |                                                          |
|           | Number of applications completed                         |
|           |                                                          |
|           | Number of patients not able to contact                   |
|           |                                                          |
|           | -   Continues to stay informed of any statutes and       |
|           |     regulations that could affect patient eligibility.   |
+-----------+----------------------------------------------------------+
| Qualif    | -   High school graduate or several years appropriate    |
| ications: |     work experience that would indicate a high level of  |
|           |     communication skills and organizational ability      |
|           |                                                          |
|           | -   Previous experience working with state Medicaid, if  |
|           |     available, or familiarity with statutes and          |
|           |     regulations that impact eligibility                  |
|           |                                                          |
|           | -   Familiarity and understanding of insurance           |
|           |                                                          |
|           | -   People oriented person                               |
+-----------+----------------------------------------------------------+

### Biller

+-----------+----------------------------------------------------------+
| Duties    | -   Responsible for completing insurance claims for      |
|           |     designated third-party payers in a timely and        |
|           |     accurate manner.                                     |
|           |                                                          |
|           | -   Responsible for correcting all errors in RPMS for    |
|           |     orphan test, missing information, etc. prior to      |
|           |     submission of claims to insurer.                     |
|           |                                                          |
|           | -   Responsible for assuring that all coding (CPT,       |
|           |     ICD-9, HCPCS, etc.) are billed in the correct manner |
|           |     to the insurance company.                            |
|           |                                                          |
|           | -   Validates compatibility and medical necessity        |
|           |     between CPT and ICD-9 coding.                        |
|           |                                                          |
|           | -   Inputs computer information for electronic           |
|           |     processing and edits of eligible claims (Medicare    |
|           |     and Medicaid) and corrects any electronic rejections |
|           |     immediately.                                         |
|           |                                                          |
|           | -   Prints, sorts, and mails manual claim forms (private |
|           |     and dental) to insurer.                              |
|           |                                                          |
|           | -   Reviews insurance return mail and determines reasons |
|           |     for return.                                          |
|           |                                                          |
|           | -   Reviews inquiries from insurance company related     |
|           |     billing specifics, such as coding timely manner.     |
|           |                                                          |
|           | -   Shares information on any significant changes in     |
|           |     coding, benefits, coding errors, etc.                |
|           |                                                          |
|           | -   Keeps in close contact with the insurer to better    |
|           |     understand their specific coding and billing         |
|           |     requirements.                                        |
|           |                                                          |
|           | -   Conducts random reviews of provider records and      |
|           |     coding as part of the quality assurance initiative.  |
|           |                                                          |
|           | -   Researches all information related to a denied claim |
|           |     and processes a corrected bill in a timely manner,   |
|           |     one that is established by the facility.             |
|           |                                                          |
|           | -   Bills the appropriate primary insurer and follows up |
|           |     that secondary insurance is paid, either manually or |
|           |     electronically.                                      |
|           |                                                          |
|           | -   Keeps abreast of CPT, ICD-9, and HCPCS coding.       |
|           |                                                          |
|           | -   Always respects the confidentiality of               |
|           |     medical/charge information in performing job duties. |
+-----------+----------------------------------------------------------+
| Qualif    | -   High school diploma                                  |
| ications: |                                                          |
|           | -   Proficiency in the use of computer systems and       |
|           |     keyboarding skills                                   |
|           |                                                          |
|           | -   Good communication skills                            |
|           |                                                          |
|           | -   Previous experience with coding and insurance        |
|           |     requirements                                         |
+-----------+----------------------------------------------------------+

### Accounts Receivable

Depending on the size of the facility, the following duties may be split
between follow-up and posting. In smaller facilities, they are combined.

+-----------+-----------------------------------------------------------+
| Duties    | -   Consistently evaluates the accuracy of third-party    |
|           |     payment.                                              |
|           |                                                           |
|           | -   Researches, reviews, and resolves any inconsistent    |
|           |     payments (under or over the expected amount).         |
|           |                                                           |
|           | -   Follows up on all outstanding accounts over 45 days,  |
|           |     post submission of the claim.                         |
|           |                                                           |
|           | -   Validates that all electronic payments have been      |
|           |     appropriately credited.                               |
|           |                                                           |
|           | -   Posts all manual payments and adjustments to patient  |
|           |     accounts in a timely and accurate manner.             |
|           |                                                           |
|           | -   Highlights rejections for billing.                    |
|           |                                                           |
|           | -   Prepares reports for billing supervisor, finance, and |
|           |     area office.                                          |
|           |                                                           |
|           | -   Researches and forwards inappropriate payments to     |
|           |     either the appropriate facility or Area office or     |
|           |     back to the insurer.                                  |
|           |                                                           |
|           | -   Regularly foresees potential problem situations and   |
|           |     intervenes to offset adverse impact.                  |
|           |                                                           |
|           | -   Checks are verified, copied, tallied, and validated   |
|           |     by supervisor or finance staff person.                |
+-----------+-----------------------------------------------------------+
| Qualif    | -   High school diploma                                   |
| ications: |                                                           |
|           | -   Previous accounting or insurance posting experience   |
|           |                                                           |
|           | -   Attention to detail                                   |
+-----------+-----------------------------------------------------------+

### Compliance Officer

+-----------+----------------------------------------------------------+
| Duties    | -   Oversees and monitoring the implementation of the    |
|           |     third party compliance program.                      |
|           |                                                          |
|           | -   Reports on a regular basis to the facility's         |
|           |     Administrative or Executive committee on the         |
|           |     progress of the implementation, any issues to date,  |
|           |     and any improvement to the facility's efficiency and |
|           |     quality of services.                                 |
|           |                                                          |
|           | -   Periodically revises the program in light of changes |
|           |     in the needs of the facility and/or in the law,      |
|           |     policies, and procedures of the government or of the |
|           |     health plans.                                        |
|           |                                                          |
|           | -   Develops, coordinates, and participates in           |
|           |     multifaceted educational and training programs that  |
|           |     focus on the elements of a compliance program.       |
|           |                                                          |
|           | -   Ensures that independent contractors who furnish     |
|           |     medical services to the facility are aware of the    |
|           |     requirements of the facility's compliance program,   |
|           |     especially with respect to contract providers, or    |
|           |     outsourced coding and billing.                       |
|           |                                                          |
|           | -   Coordinates personnel issues with the facility's     |
|           |     Human Resource Office.                               |
|           |                                                          |
|           | -   Assists the facility's finance office in             |
|           |     coordinating internal compliance review and          |
|           |     monitoring activities.                               |
|           |                                                          |
|           | -   Independently investigates and acts on matters       |
|           |     related to compliance, including the flexibility to  |
|           |     design and coordinate internal investigations and    |
|           |     monitor any imposed corrective action.               |
|           |                                                          |
|           | -   Develops policies and programs that encourage        |
|           |     supervisors and staff to report suspected fraud and  |
|           |     other improprieties without fear of retaliation.     |
|           |                                                          |
|           | -   Has the authority to review all relevant compliance  |
|           |     documents throughout the facility to include         |
|           |     relevant patient records, billing records, and other |
|           |     related data.                                        |
|           |                                                          |
|           | -   Coordinates periodic audits on health records,       |
|           |     coding, billing, and payment.                        |
+-----------+----------------------------------------------------------+
| Qualif    | -   High school graduate and Bachelor's degree           |
| ications: |                                                          |
|           | -   Preference of medical background or experience in    |
|           |     health field                                         |
|           |                                                          |
|           | -   Previous experience with quality or compliance       |
|           |     monitoring                                           |
|           |                                                          |
|           | -   Ability to communicate with individuals throughout   |
|           |     the facility                                         |
|           |                                                          |
|           | -   Understanding of state and Federal regulations       |
+-----------+----------------------------------------------------------+

## Performance Appraisal and Productivity

The performance appraisal process begins at the time of hire, with
proper orientation of new staff. Daily performance feedback is essential
to deal with errors, recognize achievements, and let employees know
where they stand.

The performance appraisal is a periodic meeting between the staff person
and supervisor to discuss the employee's job performance. This is an
opportunity for the supervisor to assess the employee's job performance
during a specified period. The discussion of job performance should
improve understanding between the staff person and supervisor regarding
job responsibility and performance expectations.

It is recommended that annual appraisals and salary reviews be held near
the same time, but not necessarily at the same meeting. Salary reviews
and adjustments may distract from the performance review and, therefore,
dilute its purpose to correct performance and encourage better job
productivity.

Timely performance appraisals are essential to maintain the credibility
of your performance appraisal process. In situations of misconduct,
disciplinary warnings should be issued to the employee.

In the absence of a scheduled discussion, there is often very little
performance feedback to the staff person. If the supervisor is too busy
to talk, the employee typically assumes that his/her performance is
okay. The other common occurrence is that the employee only hears
complaints when something goes wrong. Neither opportunity promotes a
good understanding of job expectations.

Even though typical performance reviews occur annually, an evaluation
should take place to accomplish the following:

-   **Correct poor performance**

Corrective performance decisions can be scheduled at any time when it
becomes necessary to advise the employee of performance problems and to
specify corrective action.

-   **Coach for improved performance**

Through coaching and advice, the supervisor can offer suggestions to
staff on better or more efficient ways of performing job duties. Through
a systematic assessment of the employee's skills and abilities, job
assignments can be identified to provide broader experiences or new
challenges.

-   **Justify pay adjustments**

Employee performance ratings can be used as a basis for making salary
adjustments.

-   **Evaluate candidates for promotion**

The performance appraisal serves as an excellent process to identify
employee career interests and evaluate candidates for promotion.

-   **Document personnel action**s

The performance appraisal documents personnel decisions such as
promotions, pay increases, transfers, disciplinary actions, or
discharges. In the event of subsequent legal proceedings the documented
personnel actions help to justify the supervisor's decisions. All
actions must be documented and become a part of the personnel file.

The performance appraisal may be based on the criteria of (1) most of
the time, (2) Sometimes, or (3) Infrequently.

Make sure the evaluation is based on the most current job description.
For each new employee, the job description should be reviewed in detail
with the patient. In addition, a signed form should be placed in the
employee folder that the information on the job description was reviewed
with the employee.

### Progressive Performance Evaluations

Most facilities provide an annual review where all performance
activities, good or bad, are saved and discussed on an annual basis.
There are several pitfalls related to an annual review:

-   If overall performance is satisfactory or above, the few areas in
    which staff fail to meet expectations tend to get neglected.

-   Once-a-year reviews often focus on the past three months rather than
    the actual twelve months; therefore, an accurate picture of the
    staff members' full year's worth of work is distorted or incomplete
    or both.

-   Annual reviews favor subjectivity. A supervisor's mood on the day
    the annual review is written can taint or enhance a staff person's
    evaluation.

A progressive performance evaluation is one that occurs quarterly, with
the final review being a culmination of the quarterly reviews. The value
of the Progressive Performance Evaluation is that problems and issues
can be identified and action plans designed to improve staff
performance. The quarterly reviews will also determine if staff is on
course to meet targeted facility goals.

Benefits of a Progressive Evaluation are:

-   Standards are defined and measurable -- The problems with staff who
    do not meet targeted goals with the first quarter can be identified
    and improved.

-   Staff is evaluated on their actual performance with measurable
    standards.

-   Standards can be evaluated as well -- standards can be evaluated and
    changed as changes in performance or requirements occur.

-   A cumulative record is the base for a more complete and accurate
    review of performance.

-   Staff has a good sense of where they stand. With annual reviews,
    staffs are left in the dark until year end.

### Performance Appraisal Traps and Pitfalls

Performance appraisal now carries with it a growing number of potential
legal traps, such as in the case where documentation on the performance
appraisal does not match the reason for the person being terminated.

The biggest problem or trap is lenient appraisals -- stating on the
record that the individual's performance is acceptable, when in truth it
is unsatisfactory in some respect.

Here are some guidelines to help prevent such legal traps.

-   The performance appraisal system is based on the job, with the
    appraisal criteria arising from an analysis of the legitimate
    requirements of the position.

Focus on the job, not the person who does the job and whether he/she is
meeting the expectations of the job.

-   Performance is assessed using objective criteria as much as
    possible, given the unique requirements of the job. There must be
    reasons and examples behind the assessment.

-   The appraisers have been trained in the use of the system and
    possess written instructions on how the appraisal is to be
    completed. This statement means that anyone writing or giving
    appraisals consistently use the same format and process.

-   The results of each appraisal are reviewed and discussed with the
    employee. Documentation of performance problems and efforts to
    correct them are necessary.

This is a major concern. If an employee fails to improve and must be let
go, it is necessary to prove that the employee knew about the
difficulties. The legally defensible appraisal system can be used to
demonstrate that the employee knew of the problems and was given the
opportunity to correct them.

The following areas represent common employee reactions or responses to
performance reviews that can affect the supervisor's comments.

-   **Personal problems**

Problems from one part of a person's life will have an effect on other
parts. Personal problems in one's personal life can affect work
performance.

People have different ways of handling personal problems -- some keep
problems to themselves and others bring them to work. Therefore, it is
important to understand that problems experienced outside of work by the
employee, can have adverse effects on work performance.

The evaluator needs to continually relate to the impact on work
performance and not get involved with the personal life situations.

-   **Defensiveness**

No one can understand the reactions of a staff person, especially when
less than positive evaluations are being conveyed. With a defensive
posture during the appraisal, the chances of constructive learning and
problem solving diminish dramatically.

-   **Blind spots**

Many people have their own favored beliefs, opinions, and prejudices
that prevent supervisors from seeing that person clearly.

-   **Identification**

Many supervisors not only seek employees who mirror their
qualifications, beliefs, and opinions, but also appraise employees the
same way. Therefore, it is important for the supervisor to focus clearly
and deliberately on performance only.

-   **Promises**

Do not be swayed into making promises that you cannot keep.

In summary, *do not*

-   Argue with the employee

-   Scold or reprimand

-   Dispense advice

-   Wield authority

## Examples of Performance Evaluation Criteria

The following examples of performance evaluation criteria can be used in
evaluating your staff based on current job description.

2.  The criteria listed in the following sections are guidelines only.

### Check-in Clerk Performance Evaluation Criteria

-   Demonstrates responsibility for accurately completing the check-in
    process for every patient.

-   Is reliable in keeping work schedule.

-   Is appropriately dressed.

-   Maintains professional attitude and courtesy while obtaining
    information from all patients.

-   Informs all staff in a timely manner of patient's arrival.

-   Maintains logs of activities.

-   Works with the supervisor on any potential issues or problems in a
    timely manner.

-   Cooperates with IHS staff in registration area.

### Admitting Clerk Performance Evaluation Criteria

+-----------------+-----------------------------------------------------+
| Performance     | Evaluation Criteria                                 |
| Factor          |                                                     |
+=================+=====================================================+
| Reliability     | -   Reports to work on time and/or early enough to  |
|                 |     start work at assigned time                     |
|                 |                                                     |
|                 | -   Takes responsibility for knowing and keeping    |
|                 |     work schedule                                   |
|                 |                                                     |
|                 | -   Notifies supervisor in advance of requests for  |
|                 |     scheduling changes                              |
|                 |                                                     |
|                 | -   Is appropriately dress for facility             |
+-----------------+-----------------------------------------------------+
| Cooperation     | -   Recognizes need for changes in daily routines   |
|                 |                                                     |
|                 | -   Demonstrates willingness to adjust work         |
|                 |     schedule due to illness, etc.                   |
|                 |                                                     |
|                 | -   Treats every patient and staff person with      |
|                 |     courtesy, respect, and concern                  |
+-----------------+-----------------------------------------------------+
| Initiative      | -   Maintains adequate supplies and when necessary  |
|                 |     orders new ones                                 |
|                 |                                                     |
|                 | -   Assumes responsibility for maintaining clear    |
|                 |     and orderly work area                           |
+-----------------+-----------------------------------------------------+
| Responsibility  | -   Recognizes and resolves financial problems      |
|                 |                                                     |
|                 | -   Oversees and supervises admitting office        |
|                 |     personnel in absence of immediate supervisor    |
|                 |                                                     |
|                 | -   Discerns and reports to appropriate supervisor  |
|                 |     problems requiring his or her attention         |
|                 |                                                     |
|                 | -   Follows through to complete assignments and     |
|                 |     projects                                        |
|                 |                                                     |
|                 | -   Maintains accurate bed list and count of        |
|                 |     admissions                                      |
|                 |                                                     |
|                 | -   Assigns patients to beds according to the       |
|                 |     facility procedures                             |
|                 |                                                     |
|                 | -   Places correct, complete and appropriate        |
|                 |     information in patient's record                 |
|                 |                                                     |
|                 | -   Makes sure patients' papers are properly        |
|                 |     completed                                       |
|                 |                                                     |
|                 | -   Acquires pertinent information regarding        |
|                 |     emergency admissions                            |
|                 |                                                     |
|                 | -   Add admissions requiring insurance verification |
|                 |     are handled in a timely and accurate manner     |
|                 |                                                     |
|                 | -   Demonstratives willingness to train and support |
|                 |     new staff                                       |
|                 |                                                     |
|                 | -   Problem situations are resolved appropriately   |
|                 |     and independently                               |
|                 |                                                     |
|                 | -   Plans ahead                                     |
+-----------------+-----------------------------------------------------+
| Communication   | -   Gives accurate and thorough report              |
|                 |                                                     |
|                 | -   Maintains inter- and intradepartmental working  |
|                 |     relationships                                   |
|                 |                                                     |
|                 | -   Alerts necessary people of computer shutdowns   |
|                 |                                                     |
|                 | -   Is diplomatic in dealing with financial         |
|                 |     problems, department errors                     |
+-----------------+-----------------------------------------------------+

### Registration Staff Performance Evaluation Criteria

+-----------------+-----------------------------------------------------+
| Performance     | Evaluation Criteria                                 |
| Factor          |                                                     |
+=================+=====================================================+
| Confidentiality | -   Discusses only appropriate patient information  |
|                 |     in public and private areas protecting the      |
|                 |     confidentiality and dignity of all patients     |
|                 |                                                     |
|                 | -   Releases only appropriate patient information   |
|                 |     over the telephone                              |
|                 |                                                     |
|                 | -   Maintains record confidentiality by sending all |
|                 |     internal and external written patient           |
|                 |     information in sealed envelopes                 |
|                 |                                                     |
|                 | -   Follows facility policy on release of           |
|                 |     information                                     |
+-----------------+-----------------------------------------------------+
| Patient         | -   Meets and greets all patients and patient       |
| Relations       |     families with an appropriate, friendly greeting |
|                 |                                                     |
|                 | -   Answers phones with a pleasant voice in a       |
|                 |     timely manner and transfers calls according to  |
|                 |     department policy                               |
|                 |                                                     |
|                 | -   When placing calls on hold, follow policy,      |
|                 |     returning to the caller at regular intervals,   |
|                 |     to ensure excellent communication               |
|                 |                                                     |
|                 | -   Takes and forwards all messages to the          |
|                 |     appropriate staff                               |
|                 |                                                     |
|                 | -   Responds to all complaints and forwards         |
|                 |     information to the correct person               |
|                 |                                                     |
|                 | -   Exhibits a positive attitude and provides       |
|                 |     assistance to all patients                      |
+-----------------+-----------------------------------------------------+
| Registration    | -   Ensures each patient is assigned an appropriate |
| Process         |     patient record number                           |
|                 |                                                     |
|                 | -   Obtains and inputs complete and accurate        |
|                 |     patient demographic and other information into  |
|                 |     the RPMS registration application               |
|                 |                                                     |
|                 | -   Obtains all insurance information for the       |
|                 |     patient and updates the system accordingly and  |
|                 |     timely                                          |
|                 |                                                     |
|                 | -   Obtains assignment of benefit forms,            |
|                 |     signature-on-file forms and other forms as      |
|                 |     needed                                          |
|                 |                                                     |
|                 | -   Refers appropriate patients to the Benefit      |
|                 |     Coordinator                                     |
|                 |                                                     |
|                 | -   Ensures that all patients are registered in a   |
|                 |     timely manner, prioritizing registrations       |
|                 |     during periods of high volume                   |
|                 |                                                     |
|                 | -   Enters all other data as required by the        |
|                 |     registration area for proper reporting and      |
|                 |     documentation                                   |
|                 |                                                     |
|                 | -   Problem situations are resolved appropriately   |
|                 |     and independently                               |
+-----------------+-----------------------------------------------------+
| Collection      | (for non-beneficiaries only)                        |
|                 |                                                     |
|                 | -   Accepts payments and issues receipts to all     |
|                 |     patients                                        |
|                 |                                                     |
|                 | -   Ensures accurate patient-related information    |
|                 |     and patient medical record numbers are listed   |
|                 |     with every payment accepted                     |
|                 |                                                     |
|                 | -   Inspects all checks for accuracy and            |
|                 |     completeness                                    |
|                 |                                                     |
|                 | -   Completes a tallying sheet on all checks        |
|                 |     received in a given day                         |
|                 |                                                     |
|                 | -   Accurately labels receipt envelopes and submits |
|                 |     to finance office                               |
|                 |                                                     |
|                 | -   Ensures safety of all cash, checks and charges  |
|                 |     received                                        |
|                 |                                                     |
|                 | -   Certified as collection agents, based on        |
|                 |     Financial Management and Integrity Act (contact |
|                 |     your finance officer to obtain training)        |
+-----------------+-----------------------------------------------------+
| Responsibility  | -   Adheres to and is aware of all procedures       |
|                 |                                                     |
|                 | -   Refers to policy or operation manuals as needed |
|                 |                                                     |
|                 | -   Updates supervisor on any issues                |
|                 |                                                     |
|                 | -   Follow dress code                               |
|                 |                                                     |
|                 | -   Adapts flexibly to scheduling decisions and     |
|                 |     changes to meet staffing needs                  |
+-----------------+-----------------------------------------------------+
| Quality         | -   Participates in department meetings             |
| Improvement     |                                                     |
|                 | -   Participates in in-services and training        |
|                 |     programs                                        |
|                 |                                                     |
|                 | -   Reports completely and accurately any incident  |
|                 |     that may warrant review by a Risk Manager       |
|                 |                                                     |
|                 | -   Consistently and accurately records any         |
|                 |     requested quality data and reports this         |
|                 |     information in a timely manner                  |
|                 |                                                     |
|                 | -   Consistently maintains department standards     |
+-----------------+-----------------------------------------------------+

### Patient Benefit Coordinator Performance Evaluation Criteria

-   Communication activities promote positive patient relations and
    follow through from patients

-   Increases the number of qualified eligible patients for alternate
    resources

-   Problem situations are resolved appropriately and independently

-   Participates in department meetings

-   Has developed a close working relationship with registration and has
    trained registration on the eligibility requirements for Medicaid

-   Has appropriately documented the results and outcomes in RPMS

-   Has communicated timely to billing when patients have received a
    Medicaid number

-   Knowledgeable of state and Federal alternate resource programs

-   Track status of applications and provides summarized information to
    management

-   Assists patients with appeal processes

### Biller Performance Evaluation Criteria

-   Billing is maintained at an acceptable level, minimizing backlogs

-   Accuracy and proficiency of billing are within acceptable
    measurements

-   Problem situations are resolved appropriately and independently

-   Supervisor is made aware of any unusual problems, consistent insurer
    problems, or significant issues that may impact timely reimbursement

-   Follow up with insurers is done within the timeframes established by
    the facility

-   Consistent or repetitive system errors are conveyed to the
    supervisor in a timely manner

-   Information related to follow up is accurately documented in the
    RPMS

-   Billing errors are maintained at an acceptable percentage (90% or
    95% accuracy)

-   Random periodic audits of documentation, coding and billing

-   Knowledge of HIPAA security and privacy rules for electronic
    transactions

### Accounts Receivable Performance Evaluation Criteria

-   Manual accounts are posted to patient accounts in a timely manner,
    one that is set by the facility

-   Posting errors are maintained at an acceptable level (95% and above
    accuracy)

-   Errors and issues are resolved immediately

-   Check validation and verification process is adhered to 100% of the
    time

-   Backlogs are maintained at a minimum

-   Denials are researched and appealed in a timely manner

-   Monthly reconciliation completed in a timely manner

-   Monthly accounts receivable reports provided to management in a
    timely manner

-   Monitors the unpaid accounts beyond 45 days

-   Processes refunds according to facility's policy