AGC PEDIATRICS

204 PROFESSIONAL COURT

CALHOUN, GA 30701
STANDARD OF PERFORMANCE
JOB TITLE: Health Plan Coordinator

EMPLOYEE:

DATE OF EVAL:

REPORTS TO:

DATE OF HIRE:

OFFICE: CALHOUN
CARTERSVILLE
ANNUAL EVALUATION

NEW HIRE TRAINING

90 DAY EVALUATION

Training/Evaluation Due Date:

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Training/Evaluation Completion Date:

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Employees Signature

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Date

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Evaluators Signature

___________________________
Date

Rating Score: E = Exceeds Standards

M = Meets Standard
NI = Needs Improvement

Evaluator
Rating Score

AREAS OF
PERFORMANCE

EVIDENCE/RESPONSIBILITIES OF
STANDARD COMPLIANCE

EVALUATION
TOOLS USED

ASSESSMENT

Promptly gathers patient data and identifies needs of individual cases

Identifies urgent patient requests, addresses promptly
Understands situations which require physician input
Checks messages and telephone encounters frequently, addressing
needs promptly
Checks voicemail consistently and addresses patient needs
effectively
Understands all state and private insurance company websites
Shows familiarity with claim submission process online and through
mail
Enters EOB information quickly and accurately
Understands all reason codes for claim denial and addresses denied
claims promptly
Shows understanding of all CPT coding issues and ICD-9 codes
Consistently reviews all aging accounts for submission errors
Follows up with all claim errors until account is balanced

Observation
Record Review

EDUCATION

Participates in continuing education programs and completes all

mandatory programs annually
Completes departmental clinic competency evaluations including
annual competency testing

Education Review

ADDRESSING
PATIENT NEEDS

Familiar with the needs of all vulnerable patient populations

Relays all necessary information from insurance companies to
parents
Addresses all phone messages, returning calls and maintaining
quality on all issues
Follows up on all patient issues until problems are resolved
Understands circumstances which necessitate accounts to be sent to
collections

Observation
Record Review

INSURANCE
COMMUNICATION

Observation
Record Review

Self
Evaluation
Rating

Rating Score: E = Exceeds Standards

M = Meets Standard
NI = Needs Improvement

Evaluator
Rating Score

AREAS OF
PERFORMANCE

EVIDENCE/RESPONSIBILITIES OF
STANDARD COMPLIANCE

EVALUATION
TOOLS USED

TECHNICAL
KNOWLEDGE IN
ECLINICALS

Navigates all areas of eClinicals billing tab proficiently

Records all actions taken on claims in a way that others can
understand and reproduce
Locates and files records in appropriate areas of patient documents
Communicates clearly with physicians, nurses, and front office staff
Responds to messages and telephone encounters promptly

Observation
Record Review

EDUCATION

Participates in continuing education programs and completes all

mandatory programs annually
Completes departmental clinic competency evaluations including
annual competency testing
Demonstrates agreement and behaviors consistent with the clinics
philosophy, mission, goals, policy, and procedures
Demonstrates behaviors that promote positive customer relations
with physician, staff, patients, and visitors
Follows Patients Rights Policies at all times
Comes to work as scheduled and consistently demonstrates
dependability and punctuality
Always guards patient privacy according to HIPAA regulations

Education Review

PROFESSIONALISM

COMMUNICATION
AND
DOCUMENTATION

Responds to voicemails promptly and effectively

Communicates the minimum required patient information in all
interactions with outside facilities
Communicates effectively with insurance companies regarding
coding and policy changes
Addresses all calls within expertise
Understands issues that must be brought to the Office Manager

Self
Evaluation
Rating

Observation
Record Review

Observation
Record Review

1. ASSESSMENT: Include areas identified as needing improvement as well as areas that exceed expectations
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2. CREATING AND CONFIRMING APPOINTMENTS: Include areas identified as needing improvement

as well as areas that exceed expectations
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3. ADDRESSING PATIENT NEEDS: Include areas identified as needing improvement as well as areas that
exceed expectations
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4. PERSONNEL MANAGEMENT: Include areas identified as needing improvement as well as areas that
exceed expectations
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5. TECHNICAL KNOWLEDGE IN ECLINICALS: Include areas identified as needing improvement as

well as areas that exceed expectations
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6. EDUCATION: Include areas identified as needing improvement as well as areas that exceed expectations
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7. PROFESSIONALISM: Include areas identified as needing improvement as well as areas that exceed
expectations
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8. INVENTORY MANAGEMENT: Include areas identified as needing improvement as well as areas that
exceed expectations
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9. COMMUNICATION AND DOCUMENTATION: Include areas identified as needing improvement as

well as areas that exceed expectations
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Educational plan for areas needing improvement:

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