Call center specialist

JOB PURPOSE OR MISSION : Performs multiple administrative and clerical duties within a clinic setting.

PERFORMANCE CRITERIA

CRITERIA A : Everyday Excellence Values - Employee demonstrates Everyday Excellence values in the day-to-day performance of their job.

PERFORMANCE STANDARDS :

• Demonstrates courtesy and caring to each other, patients and their families, physicians, and the community.
• Takes initiative in living our Everyday Excellence values and vital signs.
• Takes initiative in identifying customer needs before the customer asks.
• Participates in teamwork willingly and with enthusiasm.
• Demonstrates respect for the dignity and privacy needs of customers through personal action and attention to the environment of care.
• Keeps customers informed, answers customer questions and anticipates information needs of customers.

CRITERIA B : Corporate Compliance - Employee demonstrates commitment to the Code of Conduct, Conflict of Interest Guidelines, and the GHS Corporate Compliance Guidelines.

PERFORMANCE STANDARDS

• Practices diligence in fulfilling the regulatory and legal requirements of the position and department.
• Maintains accurate and reliable patient / organizational records.
• Maintains professional relationships with appropriate officials; communicates honesty and completely; behaves in a fair and nondiscriminatory manner in all professional contacts.

CRITERIA C : Personal Achievement - Employee demonstrates initiative in achieving work goals and meeting personal objectives.

PERFORMANCE STANDARDS

• Uses accepted procedures and practices to complete assignments. Uses creative and proactive solutions to achieve objectives even when workload and demands are high.
• Adheres to high moral principles of honesty, loyalty, sincerity, and fairness.
• Upholds the ethical standards of the organization.

CRITERIA D : Performance Improvement - Employee actively participates in Performance Improvement activities and incorporates quality improvement standards in his / her job performance.

PERFORMANCE STANDARDS

• Optimizes talents, skills, and abilities in achieving excellence in meeting and exceeding customer expectations.
• Initiates or redesigns to continuously improve work processes.
• Contributes ideas and suggestions to improve approaches to work processes.
• Willingly participates in organization and / or department quality initiatives.

CRITERIA E : Cost Management - Employee demonstrates effective cost management practices.

PERFORMANCE STANDARDS

• Effectively manages time and resources
• Makes conscious effort to effectively utilize the resources of the organization material, human, and financial.
• Consistently looks for and uses resource saving processes.

CRITERIA F : Patient & Employee Safety - Employee actively participates in and demonstrates effective patient and employee safety practices.

PERFORMANCE STANDARDS

• Employee effectively communicates, demonstrates, coordinates and emphasizes patient and employee safety.
• Employee proactively reports errors, potential errors, injuries or potential injuries.
• Employee demonstrates departmental specific patient and employee safety standards at all times.
• Employee demonstrates the use of proper safety techniques, equipment and devices and follows safety policies, procedures and plans.

JOB FUNCTIONS

ESSENTIAL JOB FUNCTIONS include, but are not limited to :

1. Answers telephone, greets visitors and schedules appointments.

PERFORMANCE STANDARDS :

• Courteously and professionally greets guests / answers phone calls and handles appropriately according to clinic protocols.
• Maintains master scheduling program for all areas and makes appointment schedules for all patients, via computer system according to established procedures.
• Coordinates transportation needs of patients as needed.
• Coordinates insurance coverage with patients, insurance company, and Business Office as indicated.
• Communicates special patient needs to appropriate staff.

PERFORMANCE STANDARDS :

• Enters charges accurately on the same day it is incurred.
• Coordinates charge data functions according to established procedures Types and proofs a variety of material (e.g., letters, forms, reports, etc.

from rough draft and corrected copies.

• Maintains accurate and current files of all patient records, correspondence, reports, and information, as required.
• Forwards completed discharged charts to Medical Records according to established procedures.
• Prepares patient folders and files patient information appropriately, copies charts as approved by Medical Records, faxes and files a variety of materials.
• Mails patient evaluations, progress notes, prescriptions, etc., and follows-up on all correspondence within defined time lines.

3. Performs billing functions to ensure proper billing and collections.

PERFORMANCE STANDARDS :

• Identifies and records required billing information according to insurance carrier requirements with 100% accuracy.
• Completes billing information accurately.
• Processes claims electronically with 100% accuracy and mail claims to insurance carriers daily.
• Enters documentation and adjustments through computer system to maintain a correct account balance.
• Updates system information daily according to correspondence received and processed.
• Documents any changes on a daily basis and submits information to appropriate personnel.
• Seeks clear directions to resolve issues and bring problems to a proper resolution.

4. Reviews and identifies charge discrepancies and completes all requests for rebilling from inter-department personnel.

PERFORMANCE STANDARDS :

• Reviews charge summaries on each patient bill that is produced and identifies discrepancies with 100% accuracy.
• Audits requests for accurate information.
• Completes rebilling within 10 days according to established rebilling procedures.
• Manually documents rebilling log upon completion with 100% accuracy.

5. Prepares daily production reports, maintains required records, reports, and files while evaluating account information.

PERFORMANCE STANDARDS :

• Monitors number of accounts and outstanding balances within three days of receiving report.
• Consistently applies appropriate procedures to prevent accounts from becoming delinquent or remaining unbilled.
• Initiates appropriate follow-up.

6. Performs all other duties as assigned.

SPECIFIC EXPERIENCE REQUIREMENTS

Sufficient prior experience with billing, scheduling and general office responsibilities in a clinic setting.

SPECIFIC EDUCATIONAL REQUIREMENTS

High School Diploma preferred, post high school vocational / specialized training encouraged.

SPECIAL SKILL, LICENSE AND KNOWLEDGE REQUIREMENTS

Minimum typing skills of 45 wpm, ten key by touch, data entry skills.

HIPAA REQUIREMENTS :

Maintains knowledge of and adherence to all applicable HIPAA regulations appropriate to Job Position.

SAFETY REQUIREMENTS :

Maintains knowledge of and adherence to all applicable safety practices appropriate to Job Position including but not limited to : incident reporting, handling wastes, sharps and linens, PPE, exposure control plan, hand washing, and environmental round to ensure safety,

Last updated : 2024-04-09