JOB DESCRIPTION - MEDICAL RECORDS CLERK Summary: Under the general supervision of the Clinical Director, this person must be knowledgeable of the filing system and must be able to retrieve Medical Records for all requests and file records and return. This person initiates charts for new patients and makes address and name changes in existing records. A knowledge of the established order of the chart and the ability to identify individual reports and file them in their appropriate position within the record is require. In order to relieve other employees during breaks, this person must know how to operate the switchboard. ROUTINE TASKS: With a thorough knowledge of the work involved, this person works with a high degree of independence to perform the following tasks: 1. Prepares a Medical Record for each patient. 2. Pulls the records of all patients who have appointments and completes the out guide form. 3. If a requested chart is not in the file, uses problem solving skills to search the clinic for the misplaced chart; if a thorough search does not produce the chart, seeks assistance of the Office Manager. 4. Sorts all loose medical reports that arrive in the Department, files them into the appropriate chart according to the order of the chart procedure. 5. Whn charts are returned to the file room, analyzes each one for completeness, returns any incomplete charts to the responsible provider to be completed. 6. Returns all properly completed records to the file. 7. When requested to do so, operates the telephone switchboard during other employee's coffee breaks and lunch breaks. QUALIFICATIONS: This person must be able to organize, alphabetize, and work quickly. Close visual perception, and orientation to detail and an ability to work with interruptions are necessary. This person should also have physical decterity and good telephone etiquette. Filing experience is desirable. JOB DESCRIPTION - BILLING & COLLECTIONS COORDINATOR POSITION: Billing and Collections Coordinator REPORTS TO: Office Manager RESPONSIBILITIES: Maintain a solid cash flow to the practice receivables JOB REQUIREMENTS: 1. Develop a solid understanding of coding and third party requirements. 2. Instruct the front desk personnel on how to gather correct insurance information from the patients. 3. Process all isurance and third party forms. 4. Respond to all written and telephone inquires from patients and third party payors. 5. Process all "Managed Care" paperwork. 6. Coordinate all route slip information from the front desk to the billing department. 7. Monitor payments and follow up on all upaid claims from third parties. 8. Coordinate all activities with the "Collection" department. 9. Coordinate all daily posting of receipts. 10. Coordinate all daily receipts deposit to bank. 11. Coordinate all activities in the "current billing" department. 12. Give a weekly report to the office manager regarding: a. Collection of accounts b. Claim submissions c. Claim resubmissions d. Write-offs. 13. Perform any other tasks at the request of the physician or office manager. EXPERIENCE REQUIREMENTS: Be a graduate from an accredited high school. Applicant should have one (1) year minimum medical office experience. Completion of a course in medical terminology would be helpful. Applicant should have prior computer (medical) experience. JOB RELATIONSHIPS: Patient should be able to supervise multiple employees Applicant is supervised by office manager. AUTHORITY BOUNDARIES: Reports to the office manager in all matters. JOB DESCRIPTION - MEDICAL TRANSCRIPTIONIST JOB DESCRIPTION POSITION: Medical Transcriptionist REPORTS TO: Clinical Director R.N. RESPONSIBILITIES: Maintain current, grammatically correct correspondence on all patients. JOB REQUIREMENTS: 1. Transcribe all dictated correspondence/office notes, etc. in a timely fashion. 2. Transcribe/type other material at request of Clinical Director and staff as requested. 3. Maintain chart record in proper organization as transcription is done. 4. Submit typed dictation to appropriate location/person (i.e., physician's folder, originator). 5. Erase transcribed tapes and return to physician's dictating station. 6. Check physician's folders for signed correspondence and make xerox copies of letters for patient's charts. 7. Prepare letters for mailing, i.e., place in envelope, attach postage with postage meter and place in outgoing mail. 8. File letters and office notes in patient's chart in proper order. Check chart for organization, organize as necessary. 9. Return charts with completed and filed dictation to Nursing for review and filing. REQUIREMENTS: Accurate spelling, grammer and typing skills. Be a graduate from an accredited high school. Completion of accredited course(s) in medical terminology Applicant should have one (1) year minimum medical office/hospital experience. Applicant should have prior Word Processing (medical) experience. JOB RELATIONSHIPS: Applicant should be able to work independently. Applicant is supervised by the office manager. AUTHORITY BOUNDARIES: Reports to the Clinical Director in all matters. UNIT CLERK We are all aware of the importance of physicians and nurses in the EC setting. I think, however, that another key to the proper functioning of each EC unit is the clerk. The clerk must wear many hats and perform many duties. Duties range from administrative to secretarial, from social worker to friend, and from record keeper to triage for the nurses, physicians and patients. Often, it seems the clerk must know where everyone and everything is. The clerk is the heart of the unit. The goal of the Unit Clerk is to provide loving care to the patients and their families. It is also to ensure that the EC functions smoothly and efficiently. The unit clerk is usually the first person seen by the patient. Immediately, the unit clerk begins care for each patient's needs. During the inital patient interview and registeration, a good clerk not only gathers information but, if he/she is astute, will quickly and accurately perceive the patient's level of physical pain and emotional trauma. This pain is not limited to the patient. It also extends to the relatives and loved ones. The clerk is probabl more aware of this than any other person in the unit. It is the clerk who is inundated with questions from the countless family members and visitors. It is the clerk who interacts and waits along with everyone else for further care to be rendered. Every patient who comes to an EC believes his/her problems to be an emergency. A calming, loving, caring, personable clerk can diffuse tensions and allay fears by doing little things such as listening and offering explanations. The clerk must be attentive, responsive and informative. The unit clerk must interact closely with the nurses. This is where organizational ability comes to the forefront. Nurses need things organized. The data sheets must be informative and concise. Old charts, old EKGs and x-rays can be retrieved at the time of registration and delivered to the nurse along with the patient. The clerk must be organized to process orders accurately and efficiently. This may range from ordering supplies, to arranging custodial services, to lending a helping hand during cardiopulmonary resuscitation. In addition to the patient, family and nurses, the clerk also works closely with the physicians, who at times tend to be egotistical, overbearing and demanding. The clerk must have a strong, broad shouldered, take all personality. Clerks must function in many capacities. Consequently, job stress can become great. Unit clerks suffer burnout, just like nurses and physicians. The clerk holds the unit together. JOB DESCRIPTION/PERFORMANCE EVALUATION UNIT CLERK UNIT CLERK COORDINATOR DIRECTOR APPROVAL: DATE: EMPLOYEE NAME: DEPARTMENT GI CENTER JOB CODE: EXEMPT: NON-EXEMPT: TITLE: Unit Clerk Coordinator FUNCTIONAL PURPOSE: Assumes the responsibility for maintaining clerical duties for GI Center coordinating communications and scheduling for GI Center, coordinating communications and scheduling procedures for effective functioning of department. Customer Service: Definition of customer: Patient, visitor, physician, co-worker, management, (all persons). GOAL: Incorporates and demonstrates customer service strategies in dealing with people, in order to achieve the organizations' goal of "RESPOND WITH EXCELLENT SERVICE, RESPECT AND COMPASSION." GENERAL STANDARDS - Greets patients, family, visitors, and staff pleasantly when arriving to Endoscopy Center. - Works well and cooperates with other staff members; is courteous, tactful, helpful, and has teamwork spirit. - Recognizes necessary information to the be communicated to patient and family, answering their questions appropriately and in a timely manner. - Supports the philosophy, objectives and goals of the Endoscopy Center in a positive manner. - Introduces self and responds to inquiries in a clear and pleasant manner. - Communications are factual, listens and responds to customers needs appropriately. - Meets hygiene/dress code standards required, follows department dress code policy with name tag. - Respects patient confidentiality. - Surfaces differences constructively. Uses tact and courtesy under stress. EFFECTIVENESS GOAL: Efficient processing during admission procedure. GENERAL STANDARDS: - Obtains and verifies patient admitting information. - Activates all pre-admit patients. - Enters all information accurately into computer. - Understands and completes insurance requirements. GOAL: Assist GI staff and physicians to implement and complete patient care. GENERAL STANDARDS: - Schedules GI procedures accurately and in timely fashion for efficient operation. - Understands and uses correct computer pathways to implement all physician orders. - Keeps staff notified of patient arrival for prompt admission. - Maintains control of department phone system responding promptly and relaying calls efficiently. - Demonstrates usage of paging system and follows through for referring physicians contact. - Enters all patient charges into computer daily and rechecks print outs to eliminate errors for better patient satisfaction. - Compiles all forms for each patient scheduled for procedures. - Maintains GI schedule constantly and up-dates regularly, notifying staff promptly of changes. - Delivers all medical records, charts and forms daily to proper departments. - Collects all computer results and orders promptly and delivers to staff. - Files all department forms accurately on a daily basis. COMPETENCY: GOAL: Perform the clerical duties of GI Center for patient's staff and physician to maintain organized efficient department. GENERAL STANDARDS - Displays responsibility - follows policy and procedures, seeks to solve problems, recognizes obligation to others. - Produce volume of work regularly in accordance with productivity of department. - Organizes work, plans work, meets deadlines and schedules, uses proper resources. - Accepts accountability for own practice. - Develops and implements goals in conjunction with performance evaluation. TECHNICAL QUALITY CONTROL: GOAL: Demonstrates safe performance of unit specific skills. GENERAL STANDARDS : - Attends and contributes to GI staff meetings. - Attends in-service programs when able. - Orders stock supplies to keep department functioning well. - Understands and uses clerical equipment keeping in proper functioning condition. - Trains department staff in department related computer skills. SAFETY/RISK MANAGEMENT: GOAL: Provide and maintain safe work environment. GENERAL STANDARDS: - Attends safety and infection control inservices yearly. - Maintains fire safety training. - Understands and follows universal precautions. - Practice within guidelines of AEC and GI policies and procedures. - Identifies malfunctioning equipment and notifies proper department or person. - Work reflects patient and department safety standards. RESOURCE UTILIZATION: GOAL: Collaborates with multi-disciplinary team to provide comprehensive patient care in a cost-effective manner. GENERAL STANDARDS: - Carries out requests for patient care to other areas. - Adjusts to changing patient needs, recognizes own limitations, seeks other resources. - Primarily collaborates with physician to meet patient needs. - Communicates needs of patient to other staff or manager as appropriate. ORGANIZATIONAL RELATIONSHIP: - Under the direction of the Clinical Director EDUCATION , TRAINING AND EXPERIENCE: - High School Diploma - Hospital experience - one (1) year - Computer and typing skills ADDITIONAL REQUIREMENTS: - Good verbal and written communication skills. - Proficiency in computer skills. - Excellent organizational skills. - Have flexibility to constantly changing schedule. - Able to work under stress in rapid hanging situations. JOB DESCRIPTION POSITION: Unit Clerk REPORTS TO: Office Manager / Clinical Director R.N. JOB REQUIREMENTS: 1. Patient/family respresentative 2. Greet patient/family - introduction to Unit 3. Answer phone and relay. 4. Follow through with patient information records/check lists/charts. 5. Assists with pre-op/post-op phone calls. 6. Assists patient/family to and from ambulatory surgery unit. 7. Assists patient with dressing room procedures. 8. Identify patient with name bracelet and charts with labels. 9. Liaison with medical records/business office/insurance department. 10. Assists with O.R./P.A.R. charges, records and inventory. 11. Assists with supplies ordering for P.A.R./O.R. 12. Assists with communication between Unit and hospital for patient admission to hospital when needed. 13. Could utilize to help with twelve (12) lead EKGs to done pre- operatively. 14. Assists in relaying patient information to family during patient's progress through unit/pre-op/post-op stages. 15. Scheduling of procedures and anesthesia. 16. Keeping yearly surgery, PAR, anesthesia, etc., records. 17. Preoperative assessment - lab, x-ray, EKG 18. Assist in preoperative teaching - Do's and Don'ts of teaching with a check list. 19. Writing schedule on board. 20. Clerical position. 21. Work as part of the O.R. staff/promote team work. 22. Do whatever is requested of Clinical Director within his/her scope. JOB DESCRIPTION FOR CLERICAL EMPLOYEES: Job Title: Medical Records Clerk Summary: Under the general supervision of the medical record manager, this person must be knowledgeable of the filing system and must be able to retrieve medical records for all requestes and file records on return. This person initiates charts for new patients and makes address and name changes in existing records. A knowledge of the established order of the chart and the ability to identify individual reports and file them in their appropriate position within the record are required. In order to relieve other employees during their breaks, this person must know how to operate the switchboard and how to make appointments. Routine Tasks: With a thorough knowledge of the work involved, this person works with a high degree of independence to perform the following tasks: 1. Prepares a medical record and patient index card for all new patients. 2. Understands the purpose of and is able to use the patient index file. 3. If requested chart is not in file, uses problem-solving skills to search the clinic for the misplaced chart; if a thorough search does not produce the requested record, seeks the assistance of the medical record manager. 4. Pulls the records for all patient telephone inquiries, or other record requests, verifies that all current test results are on the record, delivers the record to the requesting party. 5. Sorts all loose medical reports that arrive in the medical record department, files them in the appropriate record folder according to the "order of the chart" procedure. 6. When records are returned to the file room, analyze each chart for completeness, returns any incomplete charts to the responsible provider to be completed. 7. Returns all properly completed records to the file, if laboratory reports accumulated in the record room while the chart was out of the files, files the laboratory reports in the proper place within the chart. 8. When requested to do so, operates the telephone switchboard during other employee's coffee and lunch breaks, following the established procedure. 9. When requested to so, covers the reception desk during employee's lunch and coffee breaks, following the established procedure. 10. At six-month intervals, audits all charts in the file for correct filing sequence. QUALIFICATIONS: This person must be able to organize, alphabetize, and work quickly. Close visual perception, and orientation to detail, and an ability to work with interruptions is necessary. This person should also have physical dexterity and good telephone etiquette. Filing experience is desirable. ORIENTATION OBJECTIVES FOR GASTROENTEROLOGY NURSES 1. To enable the nurse to given endoscopic nursing care to the patient during the gastroenterology procedure. 2. To provide the nurse with sound principles of aseptic technique and microbiology, and enable her to apply these principles. 3. To provide continuity of quality nursing care for the patient undergoing endoscopic procedures. 4. To assist the nurse in transferring her general knowledge of nursing to this speciality area of nursing care. 5. To assist the nurse to assure her role as a gastroenterology tech assistant or circulating nurse, while caring for the patient having an endoscopic procedure, as a team member. 6. To assist the nurse to learn how to supervise non-professional co-worker. 7. To assist the nurse in developing sound interpersonal relations with the patients, co-workers, and medical staff. 8. To assist the nurse in understanding the medicolegal aspects of gastroenterology nursing. 9. To assist the nurse in learning how to cope with stressfull situations. 10. To assist the nurse in learning how to manage her time. 11. To assist the nurse in learning to economize supplies and equipment. ORIENTATION PROCEDURE FOR ENDOSCOPY NURSES PURPOSE: TO PROVIDE A COMPLETE ORIENTATION PROGRAM FOR ALL ENDOSCOPY NURSES. DATE 1. FACILITY TOUR AND INTRODUCTION. 2. READ AND UNDERSTAND POLICY AND PROCEDURE MANUAL, Q.A. MANUAL, PHARMACY MANUAL AND FIRE MANUAL. 3. DEMONSTRATES ABILITY TO TAKE VITAL SIGNS. 4. DEMONSTRATES COMPREHENSION OF USE OF EQUIPMENT. 5. FOLLOWS PROPER PROCEDURE IN DISINFECTING EQUIPMENT SCOPES & ACCESSORIES BY OBSERVATION OF NURSE MANAGER. 6. DEMONSTRATES ABILITY TO START I.V.S. 7. DEMONSTRATES KNOWLEDGE OF MEDICATIONS FREQUENTLY USED IN THE ENDOSCOPY UNIT. 8. HAS CPR CERTIFICATION RENEWED YEARLY. 9. DEMONSTRATES ABILITY TO CARRY OUT INFECTION CONTROL PROCEDURE. 10. DEMONSTRATES ABILITY TO CARRY OUT BODY SUBSTANCE ISOLATION ACCORDING TO OSHA REGULATIONS. 11. HAS VIEWED UNIVERSAL PRECAUTIONS VIDEO (OSHA FILM) 12. HAS VIEWED - EGDs - COLONOSCOPIES - FLEXES 13. HAS RECEIVED OR REFUSED HBV VACCINE 14. VERBALIZES KNOWLEDGE OF EMERGENCY PROCEDURE. 15. VERBALIZES KNOWLEDGE OF FIRE AND DISASTER PROCEDURE. 16. DEMONSTRATES KNOWLEDGE OF LAB PROCEDURES. 17. DEMONSTRATES KNOWLEDGE AND ABILITY TO COMPLETE UNUSUAL OCCURENCES. 18. DEMONSTRATES ABILITY TO DOCUMENT SIGNING AND WASTE OF CONTROLLED SUBSTANCES. 19. DEMONSTRATES KNOWLEDGE OF REPORTING ADVERSE DRUG REACTIONS. 20. DEMONSTRATES KNOWLEDE AND ABILITY TO ORDER SUPPLIES. 21. HAS BEEN OBSERVED BY CLINICAL DIRECTOR IN ROLES OF GI ASSISTANT AND CIRCULATING NURSE DURING ENDOSCOPY PROCEDURES. 22. DEMONSTRATES ABILITY TO INSTRUCT PATIENT IN USE OF NURSE CALL SYSTEM. 23. DEMONSTRATES KNOWLEDGE AND ABILITY TO USE COMPUTERS ESPECIALLY ENDOSCOPY SCHEDULING SECTION. 24. DEMONSTRATES ABLITY TO COMPLETE ENDOSCOPY RECORD AND KNOWLEDGE OF COMPLETE CHART. 25. HAS READ AND SIGNED EMPLOYEE MANUAL. 26. HAS READ AND SIGNED JOB DESCRIPTION.