| These descriptions will not perfectly fit all practices, | | | | - Reviews orders written by providers and |
| this is just a generalization. Each practice divides | | | | determines where test and procedures may be |
| duties based on the number and skills of the staff in | | | | performed based on patient's insurance |
| their office, and the providers' specialties. These | | | | - May provide the patient with information about the |
| descriptions should help to define what the basic | | | | test or procedure cost and what the patient's |
| tasks are in most practices. | | | | financial responsibility is estimated to be |
| Front Desk/Check-In - Usually the first person you | | | | - Pre-authorizes, pre-certifies, or pre-notifies the test |
| meet in a medical practice, this person sets the tone | | | | or procedure if required by the patient's insurance |
| for the practice by the way she greets you and | | | | company |
| makes you feel expected and welcome | | | | - Schedules the test or procedure |
| - Greets patients and visitors to the practice | | | | - Provides the patient with information about |
| - Registers patients in the practice management | | | | preparation for the test or procedure |
| system which may mean entering information given | | | | Lab Technologist/ Phlebotomist - lab employees must |
| verbally or on registration forms | | | | be quality-minded and must inspire confidence in |
| - Collects identification and insurance cards and copies | | | | patients that they will not be hurt while taking blood, |
| or scans them for the record, may photograph the | | | | or be stuck unnecessarily. |
| patient for the record | | | | - Receives laboratory requisitions from provider and |
| - May collect co-pays or other monies | | | | collects specimens according to provider order |
| - Prints encounter form (also called superbill, routing | | | | - Provides Medicare patients with an Advance |
| slip, or fee ticket) with updated information, or | | | | Beneficiary Notice if any lab test or procedure to be |
| updates information on the encounter form | | | | performed in the office will not be covered by |
| - Has patient sign financial agreement, receipt of | | | | Medicare |
| privacy policy, benefits assignment, etc. | | | | - Performs tests or packages specimens to be |
| - May answer phone calls, take messages and make | | | | transported to reference lab |
| appointments | | | | - Receives results back from the labs and matches |
| - Directs visitor (drug reps, salespersons, etc.) | | | | them to charts |
| appropriately | | | | - Performs lab controls daily and checks and records |
| Medical Records - although medical records positions | | | | temperatures on lab refrigerators and freezers |
| are often entry-level positions in a medical office, a | | | | Check-out Desk - a firm, yet pleasant person at the |
| practice lives and dies by its medical records | | | | check-out desk is important to ensure that |
| management, which needs to be as close to perfect | | | | over-the-counter collections are maximized. |
| as possible. | | | | - Reviews services received by patients, checking to |
| - Primary responsibility for the integrity and | | | | make sure that all services received were checked |
| management of the medical record, whether paper | | | | on the encounter form |
| or electronic | | | | - Enters charges in the computer system for services |
| - Controls record filing (paper) or indexing (electronic) | | | | received |
| - Fulfills requests by patients, attorneys, insurance | | | | - Tells patient if any additional monies are owed if |
| companies, and social security for release of records | | | | co-pay was collected at check-in |
| - May manage paper faxes and messages by | | | | - May sign patient on to a payment plan if needed |
| attaching to charts and delivering to provider | | | | - Takes monies owed, posts monies and produces a |
| - May prepare paper charts for chart audits by | | | | receipt for the patient |
| payers or others | | | | - Makes return appointment for the patient if |
| - May be the HIPAA Officer | | | | needed, or enters recall into the practice |
| Medical Assistant, LPN or RN - typically the person | | | | management system |
| who escorts patients from the waiting area to the | | | | Biller or Collector - these employees are the bulldogs |
| exam rooms, this person must be friendly and inspire | | | | of the industry and easily manage the day-to-day |
| confidence in the patients. | | | | changes of the insurance plans that make getting |
| - May assist Physician, Nurse Practitioner or Physician | | | | reimbursed an art. |
| Assistant with procedures | | | | - Corrects claims that are rejected from the claims |
| - Depending on state laws, may give injections | | | | scrubber, clearinghouse or payer |
| - May perform procedures independently (ear wax | | | | - Files secondary and tertiary claims as needed, |
| removal, staple removal, etc.) | | | | electronically or via paper |
| - Provides Medicare patients with an Advance | | | | - Posts receipts from insurance companies and |
| Beneficiary Notice if any lab test or procedure to be | | | | patients and edits any electronic remittance advice; |
| performed in the office will not be covered by | | | | may post from lockbox account on the web |
| Medicare | | | | - May prepare deposits and/or make deposits |
| - May perform phlebotomy (draw blood) | | | | - Generates patient statements |
| - May collect specimens, perform basic laboratory | | | | - May check eligibility on patients with appointments |
| tests and chart results | | | | and call patients whose insurance is not active (*may |
| - Provides patient education verbally and by providing | | | | be delegated to a financial counselor if this position |
| written materials | | | | exists) |
| - May schedule tests or procedures ordered by the | | | | - Calls patients who have not made payments in |
| provider | | | | response to statements |
| - May schedule surgery and prepare surgery packets | | | | - May turn patients over to third-party collectors |
| for providers (*this may be delegated to a surgery | | | | - Takes phone calls from payers or patients about |
| scheduler if this position exists) | | | | billing issues and resolves issues |
| - Calls patients about test or procedure results; | | | | Coder - this person must have an excellent grasp of |
| returns patients calls with answers after consulting | | | | anatomy, physiology and medical terminology to |
| with provider | | | | make sure that every service that is performed is |
| - Prepares exam room for procedures (PAP smears, | | | | reflected correctly in the codes. |
| excisions, etc.), marks specimens for lab and | | | | - Reviews notes from inpatient or outpatient |
| pathology | | | | encounters and codes them according to the |
| - Cleans exam room after each patient and stocks | | | | documentation |
| exam and procedure rooms with supplies | | | | - May post charges for services rendered |
| - May be responsible for ordering office medications | | | | - Audits chart documentation for quality purposes to |
| and medical supplies | | | | ensure that provider coding and documentation is |
| - May perform lab controls daily and check and | | | | synchronous |
| record temperatures on lab refrigerators and | | | | - Introduces changes in procedure (HCPCS) and |
| freezers | | | | diagnosis (ICD-9) codes and educates staff on the |
| Triage Nurse - the triage nurse must have a wealth | | | | use of new codes |
| of nursing knowledge at her command as well as an | | | | - Ensures encounter forms and practice management |
| intuitive sense of when a patient needs to be seen in | | | | software is updated appropriately with new and |
| the office, and when they do not. | | | | deleted codes |
| - Takes incoming calls from patients and gives them | | | | - May be delegated the Compliance Officer |
| medical advice according to predetermined nursing | | | | Billing Supervisor - this person can do every task |
| protocols | | | | required in the department and may need to as |
| - Makes decisions about patients needing to be seen | | | | volumes fluctuate from month to month. A fine |
| urgently, same day or next day | | | | investigative and deductive mind is needed. |
| - May be delegated callbacks from providers or other | | | | - Reviews the work of coders, billers and collectors |
| nurses | | | | and performs quality audits to benchmark acceptable |
| - May see walk-in patients and triage their condition | | | | error rates |
| Lead Nurse, Charge Nurse, or Nurse Supervisor - this | | | | - Prepares or reviews deposits and tracks daily |
| person must have the respect and trust of the | | | | charge, collection, write-off and deposit information, |
| physicians as well as the other clinical staff, and is | | | | watching for monthly aberrations by payer or date |
| relied upon to make good decisions in the case of a | | | | - Reviews Accounts Receivable (A/R) reports, |
| medical or other emergency. | | | | looking for trending or specific problems to be |
| - Assigns clinical staff specific responsibilities | | | | addressed with staff or payers |
| - Manages clinical staff schedules, using agency or | | | | - Brings to the attention of the Office Manager or |
| temporary staff as needed | | | | Administrator any issues with non-standard payment |
| - Performs annual competency exams on staff | | | | trends, denials or non-covered services. |
| - Ensures all staff are current on licenses, continuing | | | | - Performs evaluations for billing department staff |
| education and CPR | | | | - Takes escalated patient complaints |
| - Problem-solves patient issues | | | | - May credential providers with new payers or |
| - May be responsible for ordering office medications | | | | recredential providers with payers or hospitals |
| and medical supplies | | | | Office Manager, Practice Administrator, or Practice |
| - Has responsibility for medication sample closet | | | | Manager - this is the top position in most private |
| upkeep | | | | practices and may report to a managing physician or |
| - May perform annual evaluations fro clinical staff | | | | the physician board. In hospital-owned practices, this |
| - Responsible for equipment maintenance and makes | | | | person reports to a Vice President of Clinics, or the |
| recommendations for medical equipment as needed | | | | COO or CEO. |
| - May be the Patient Safety Officer and the | | | | - Performs all human resource functions for the |
| Worker's Compensation Coordinator | | | | practice |
| Referral Clerk - this person must have excellent | | | | - Has ultimate responsibility for all money flowing in |
| organizational skills and must be detail-oriented to | | | | and out of the practice - makes deposits, pays bills, |
| ensure that each patient receives the referral needed | | | | etc. |
| and that it will be covered by their insurance plan. | | | | |