TASKS

GOALS

MEASURING PERFORMANCE

Business Office Manager

? Supervises and coordinates duties
? Ensures HR and OIG compliance
? Acts as administrator's assistant
? Acts as physician office liaison
? Performs multiple business office tasks

? Auditing business office performances daily, weekly, monthly

? Patient satisfaction questionnaire
? Administrator review

Scheduler

? Schedules procedures and pre-op visits
? Determines if procedures are ASC-approved
? Responsible for time, anesthesia, special equipment
? Enters demographics/insurance information

? All scheduling completed
? All patients entered in computer
? Scheduling form given to insurance verification specialist

? Verify accuracy of tomorrow's schedule
? Determine if cases scheduled for future dates have been entered
? Scan schedule for any possible non-ASC-approved procedures

Insurance Verification Specialist

? Verifies patient's insurance eligibility/benefits
? Records patient information in computer
? Obtains required pre-authorizations

? Minimum one week ahead in verification - preferably two weeks

? Review report showing scheduled patients who haven't had insurance verification performed
? Only exceptions should be Medicare, new add-ons, self-pays

Patient Financial Counselor

? Contacts patients regarding financial responsibility
? Notes agreements in computer
? If necessary, arranges payment plans
? Alerts front desk of patient responsibility

? Minimum one week ahead in financial counseling - preferably two weeks

? At least weekly, review all financial counseling notes for next two days' surgery schedules

TASKS

GOALS

MEASURING PERFORMANCE

Coding Specialist

? From operative notes, codes (CPT and ICD-9) all facility services
? Communicates with physicians' offices when required
? Understands/conforms to compliance regulations

? Coding completed within 48 hours of receipt of operative note

? Audit date of coding against date of surgery on 50 percent of patients for each week

Billing Specialist

? Enters claim information from coder
? Balances daily report with schedule
? Submits electronic and paper claims promptly
? Sends timely patient statements

? Claims submitted within 24 to 48 hours of date of surgery
? Patient claims sent within 24 hours of change of guarantor

? Compare claims' batch date to date of surgery daily
? Verify that electronic claims have been submitted and reconciled

Posting Specialist

? Posts payments to accounts
? Compares insurance payments to contracts
? Transfers balance to secondary insurance/patient
? Balances daily entries against deposit
? Logs denials and initiates appeals

? Payments posted within 24 hours of deposit
? Denials and appeals initiated within 24 hours of posting

? Compare posting batches to deposits daily

Collections Specialist

? Follows up on all appeals and denials
? First contact 15 days, thereafter every 30 days ? enforces state prompt payment laws
? Answers patient/insurance inquiries
? Reviews credit balances/ensures appropriate and timely refunds

? Days in A/R fewer than 55
? A/R over 120 days less than 10 percent of total A/R

? Check for trends/problems on A/R summary report
? Review collector's collection notes - ensure all accounts being worked
? Review credit balance report to determine status

Receptionist

? Facility telephone operator
? Distributes mail
? Orders business office supplies
? Cleans/stocks patient refreshment area
? Greets patients, reviews demographics, copies insurance cards
? Prepares upcoming surgical charts
? Collects patient payments

? Phone calls and mail are being distributed accurately and on time
? Charts are assembled and ready for next day by day's end
? Daily payment log balances

? Review patient comments on satisfaction questionnaires
? Determine if patients are admitted in timely manner
? Verify next day's charts completed
? Verify all mail has gone out

Clinical Records Specialist

? Maintains facility's clinical records
? Provides physicians' copies
? Provides charts for QI assessment
? Ensures clinical charts are retained in a fireproof locked cabinet or area

? Clinical records to be completed within 30 days of DOS, or as required by medical staff by-laws

? Verify all patient charts are stored in clinical records area and secured appropriately
? Audit at least 5 percent of clinical charts for accuracy and timeliness

Accounts Payable Representative

? Combines/copies packing slips, purchase orders, invoices, statements
? Obtains appropriate vendor credits
? Issues checks in timely manner
? Researches refund requests

? All bills paid on time
? All refunds researched/paid within 30 days of request
? All paid bills and attachments filed at time of check issue

? Compare date of invoice receipt with date of payment
? Check on vendor discounts received
? Run report on credit balances

Medical Transcriptionist

? Transcribes dictated operative notes
? Copies to clinical records and physician offices
? Makes applicable physician corrections to reports
? Maintains delinquent dictation log

? 24-hour turnaround from time of dictation to completion
? Copies to chart and offices within 48 hours
? Notifies physicians of delinquent dictation

? Check delinquent dictation log
? Note date of DOS, date of dictation and date transcribed

Credentialing Specialist

? Gives approved applicants credentialing packet
? Performs primary source verification
? After credentialing process, obtains governing body OK; notifies practitioner of privilege status
? Notifies practitioners of reapplications and renewals

? Packet sent to applicant within 24 hours of approval
? Primary source verification completed within 30 days
? Tickler system initiated for reapplications

? Ongoing reports on status of applications to administrator
? Completed credentialing charts prepared for board approval