POSITION DESCRIPTION / PERFORMANCE EVALUATION
Name: _______________________________________
Job Title: Medical Claims Processor Supervised by: CFO/Business Office Manager Prepared by: __________________________________ Approved by: ___________________________ Date: ________________________________________ 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 Performance is clearly outstanding;Performance is superior – it far exceeds standards or expectations;Performance is exceptional on a continuous basis.
G = Good Performance generally meets or exceeds standards or expectations;Attains all or nearly all of position objectives.
S = Satisfactory Performance is adequate – it meets standards or expectations, and is developing within the position.
NI = Needs Improvement 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 XPACK system.
5 4 3 2 1
Files Medicare secondary claims. 5 4 3 2 1
Completes follow-up & work on problems with rejected or returned claims of all financial classes, and researches unpaid claims.
5 4 3 2 1
Follow-up on new claims – IP, Observation (OBV), SB, Ambulatory Procedure (AP) claims after initial filing (30 days).
5 4 3 2 1
Once a year, submit Ambulatory, IP, and SB claims to State of Oklahoma for review and correct any errors found.
5 4 3 2 1
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Professional Requirements: E G S NI U
Completes annual education requirements. 5 4 3 2 1
Maintains regulatory requirements, including all state and federal regulations. 5 4 3 2 1 Adheres to the Group II level of HIPAA Minimum Necessary Standard when
using, disclosing or requesting Protected Health Information (PHI).
5 4 3 2 1
Reports to work on time and as scheduled. 5 4 3 2 1
Wears identification while on duty. 5 4 3 2 1
Attends annual review and departmental inservices as needed. 5 4 3 2 1 Works at maintaining a good rapport and a cooperative working relationship
with physicians, departments and staff.
5 4 3 2 1
Represents the organization in a positive and professional manner. 5 4 3 2 1 Acts proactively in managing time, workload and other departmental duties. 5 4 3 2 1 Resolves personnel concerns at the departmental level, utilizing the grievance
process as required.
5 4 3 2 1
Ensures compliance with policies and procedures regarding department operations, fire, safety and infection control.
5 4 3 2 1
Effectively and consistently communicates departmental operations to the supervisor.
5 4 3 2 1
Complies with all organizational policies regarding ethical business practices. 5 4 3 2 1 Communicates the mission, ethics and goals of the facility, as well as the focus
statement of the department.
5 4 3 2 1
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.
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DESCRIPTION OF
DESCRIPTION OF
DESCRIPTION OF
DESCRIPTION OF
PHYSICAL DEMANDS
PHYSICAL DEMANDS
PHYSICAL DEMANDS
PHYSICAL DEMANDS
JOB TITLE: Medical Claims Processor DEPARTMENT: Business Office
NAME: # HOURS/WORKDAY: 8
DEVELOPED BY: DATE DEVELOPED: 2/25/05
MANAGER SIGNATURE: DATE:
CHECK APPROPRIATE BOX FOR EACH OF THE FOLLOWING ITEMS TO BEST DESCRIBE THE EXTENT 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.
Amount of Time None up to 1/3 1/3 to 1/2 2/3 and more Stand: X Walk: X Sit: X Talk or hear: X Use hands to finger, handle or feel: X
Push/Pull: X Stoop, kneel, crouch or crawl: X
Reach with hands and arms: X Taste or smell: X
This job requires that weight be lifted or force be exerted. Show how much and how often by checking the appropriate boxes below.
Amount of Time None up to 1/3 1/3 to 1/2 2/3 and more Up to 10 pounds: X Up to 25 pounds: X Up to 50 pounds: X Up to 100 pounds: X More than 100 pounds: X
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.
Amount of Time None up to 1/3 1/3 to 1/2 2/3 and more Wet, humid conditions (non-weather): X
Work near moving mechanical parts: X Fumes or airborne particles: X Toxic or caustic chemicals: X Outdoor weather conditions: X Extreme cold (non-weather): X Extreme heat (non-weather): X Risk of electrical shock: X Work with explosives: X Risk of radiation: X Vibration: X
The typical noise level for the work environment is: Check all that apply.
Very Quiet Loud Noise Quiet Very Loud Noise x Moderate Noise
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+
A. Right only B. Left Only
C. Both X
Repetitive use of hands
PERFORMANCE EVALUATION CONTINUATION PAGE
Staff Member: ___________________________________
Job Title: ________________________
Performance Evaluation Score:
# of total points achieved
___________
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
Administration Comments:
Recommended Goals/Actions:
Staff Member Comments:
Actions Recommended by Administration: Current Wage: _____________ New Wage: __________
Performance Review Only
Cost of Living Increase: __________
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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)
