POSITION DESCRIPTION / PERFORMANCE EVALUATION Name: Job Title: Medical Claims Processor Prepared by: Date: Supervised by: CFO/Business Office Manager Approved by: Date: Job Summary: Reviews and enters medical claims into claims system. Corresponds as needed with subscribers and providers to follow up on claims and payments. Complete and submit monthly billing and production reports. DUTIES AND RESPONSIBILITIES: E = Excellent G = Good S = Satisfactory NI = Needs Improvement Performance is clearly outstanding;performance is superior it far exceeds standards or expectations;performance is exceptional on a continuous basis. Performance generally meets or exceeds standards or expectations;attains all or nearly all of position objectives. Performance is adequate it meets standards or expectations, and is developing within the position. Fails to meet one or more job expectations. U = Unacceptable Performance is below accepted levels;fails to meet most job expectations. Demonstrates Competency in the Following Areas: E G S NI U Demonstrates a working knowledge of insurance coverage, policies and procedures. Files all claims In-patient (IP), Out-patient (OP), Emergency Room (ER), Swing Bed (SB), Therapy (T) thru PACK system. Files Medicare secondary claims. Completes follow-up & work on problems with rejected or returned claims of all financial classes, and researches unpaid claims. Follow-up on new claims IP, Observation (OBV), SB, Ambulatory Procedure (AP) claims after initial filing (30 days). Once a year, submit Ambulatory, IP, and SB claims to State of Oklahoma for review and correct any errors found. Reviews and submits premit claims. Performs business office functions related to claims processing. Prepare and submit patient monthly billing statements. Conducts end of month closing. Backs up claim system daily. Assists at front desk and answering phones as needed. Professional Requirements: E G S NI U Adheres to dress code, appearance is neat and clean. 1
Professional Requirements: E G S NI U Completes annual education requirements. Maintains regulatory requirements, including all state and federal regulations. Adheres to the Group II level of HIPAA Minimum Necessary Standard when using, disclosing or requesting Protected Health Information (PHI). Reports to work on time and as scheduled. Wears identification while on duty. Attends annual review and departmental inservices as needed. Works at maintaining a good rapport and a cooperative working relationship with physicians, departments and staff. Represents the organization in a positive and professional manner. Acts proactively in managing time, workload and other departmental duties. Resolves personnel concerns at the departmental level, utilizing the grievance process as required. Ensures compliance with policies and procedures regarding department operations, fire, safety and infection control. Effectively and consistently communicates departmental operations to the supervisor. Complies with all organizational policies regarding ethical business practices. Communicates the mission, ethics and goals of the facility, as well as the focus statement of the department. Total Points 2
Education/Experience Requirements: High school diploma or GED. Prefer previous experience with insurance claims processing. Ability to meet deadlines and manage claims in different stages. Skills: Basic computer knowledge Able to communicate effectively in English, both verbally and in writing. Physical Demands: For further description of physical demands of position, including vision, hearing, repetitive motion and environment, see following description. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position without compromising patient care. ======================================================================================= I have received, read and understand the Position Description/Performance Evaluation above. Name/Signature Date Signed 3
JOB TITLE: Medical Claims Processor DEPARTMENT: Business Office NAME: # HOURS/WORKDAY: 8 DEVELOPED BY: DATE DEVELOPED: 2/25/05 MANAGER SIGNATURE: DATE: DESCRIPTION OF PHYSICAL DEMANDS CHECK APPROPRIATE BO FOR EACH OF THE FOLLOWING ITEMS TO BEST DESCRIBE THE ETENT OF THE SPECIFIC ACTIVITY PERFORMED BY THE STAFF MEMBERS IN THIS POSITION PHYSICAL DEMANDS On-the-job time is spent in the following physical activities Show the amount of time by checking the appropriate boxes below. Stand: Walk: Sit: Talk or hear: Use hands to finger, handle or feel: Push/Pull: Stoop, kneel, crouch or crawl: Reach with hands and arms: Taste or smell: Amount of Time None up to 1/3 1/3 to 1/2 2/3 and more This job requires that weight be lifted or force be exerted. Show how much and how often by checking the appropriate boxes below. Up to 10 pounds: Up to 25 pounds: Up to 50 pounds: Up to 100 pounds: More than 100 pounds: Amount of Time None up to 1/3 1/3 to 1/2 2/3 and more This job has special vision requirements. Check all that apply. x Close Vision (clear vision at 20 inches or less) Distance Vision (clear vision at 20 feet or more) Color Vision (ability to identify and distinguish colors) Peripheral Vision (ability to observe an area that can be seen up and down or to the left and right while eyes are fixed on a given point) Depth Perception (three-dimensional vision; ability to judge distances and spatial relationships) x Ability to Adjust Focus (ability to adjust eye to bring an object into sharp focus) No Special Vision Requirements Specific demands not listed: Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position. WORK ENVIRONMENT This job requires exposure to the following environmental conditions. Show the amount of time by checking the appropriate boxes below. Wet, humid conditions (non-weather): Work near moving mechanical parts: Fumes or airborne particles: Toxic or caustic chemicals: Outdoor weather conditions: Extreme cold (non-weather): Extreme heat (non-weather): Risk of electrical shock: Work with explosives: Risk of radiation: Vibration: The typical noise level for the work environment is: Check all that apply. Very Quiet Loud Noise Quiet Very Loud Noise x Moderate Noise Amount of Time None up to 1/3 1/3 to 1/2 2/3 and more Hearing: x Ability to hear alarms on equipment Ability to hear patient call Ability to hear instructions from physician/department staff REPETITIVE MOTION ACTIONS Number of Hours Repetitive use of foot control 0 1-2 3-4 5-6 7+ C. Both Repetitive use of hands C. Both Grasping: simple/light C. Both Grasping: firm/heavy C. Both Fine Dexterity C. Both 4
PERFORMANCE EVALUATION CONTINUATION PAGE Staff Member: Job Title: Performance Evaluation Score: # of total points achieved Administration Comments: 125 100 points = Excellent 99 75 = Good 74 50 = Satisfactory 51 25 = Needs Improvement 24 0 = Unacceptable 100% merit increase 100% merit increase 75% merit increase 50% merit increase 25% merit increase Recommended Goals/Actions: Staff Member Comments: Actions Recommended by Administration: Current Wage: New Wage: Performance Review Only Next Performance Review on: Acknowledgement of Job Description Cost of Living Increase: Salary Increase: Total Increase: Salary Increase Denied Staff Member Signature Date Administration Signature Date 5
PERSONNEL MEMBER ANNUAL PROFESSIONAL PERFORMANCE AND COMPETENCY EVALUATION As a member of the Okeene Municipal Hospital s personnel team, your comments and input are important to both our continuing development and quality provision of patient care and services. Your continued professional growth and job satisfaction are primary goals of the hospital. The administrative team and your department supervisor are interested in your comments regarding the following: 1-5 (1 = poor, 5 = excellent) 1. How would you rate your current job satisfaction level? 2. How would you rate your current job performance? 3. How would you rate the organization s provision of personnel benefits? 4. How would you rate the organization s provisions for personnel continuing education? 5. How would you rate the organization s physical working environment? 6. How would you rate the organization s emotional working environment? 7. List your professional goals: 8. List any departmental goals that may differ from professional goals (include educational and performance goals): 9. Is there anything the organization can do to help you achieve any of these goals? 10. If so, please describe: 11. Comments you feel may assist the organization with improving personnel satisfaction levels: Note: This organization pledges to utilize information provided for the sole purpose of improving personnel satisfaction and assisting the author with achievement of advanced personal and/or professional growth. 6