AGC PEDIATRICS
204 PROFESSIONAL COURT
CALHOUN, GA 30701
STANDARD OF PERFORMANCE
JOB TITLE:
Referral Coordinator
REPORTS TO:
EMPLOYEE:
DATE OF EVAL:
DATE OF HIRE:
OFFICE: CALHOUN
CARTERSVILLE
ANNUAL EVALUATION
NEW HIRE TRAINING
90 DAY EVALUATION
Training/Evaluation Due Date:
___________
Training/Evaluation Completion Date:
___________
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Employees Signature
___________________________
Date
____________________________
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 physical and cultural
needs of individual cases
Identifies urgent referral requests, addresses promptly
Understands instances which require prior authorization
Observation
Record Review
CREATING AND
CONFIRMING
APPOINTMENTS
Obtains up-to-date contact information for specialists
Associates diagnoses with proper specialties
Confirms specialist practice policy regarding patient insurance
Determines patient preference for location of specialist
Communicates needs of patient clearly and politely to specialist staff
Obtains all information needed for the patient prior to appointment
Communicates needs of specialist clearly and politely to patient,
addresses any questions or concerns from parent
Delivers all necessary information to parent including specialist
phone number, any instruction from specialist, and appointment
information
Empowers parent to take control of appointment process
Observation
Record Review
COMMUNICATING
WITH STATE AND
PRIVATE
INSURANCE
Understands all web-enabled insurance sites thoroughly
Able to obtain insurance information, confirm eligibility, and obtain
prior authorization for necessary services
Knows which procedures require prior authorizations for which
insurances
Communicates effectively with insurance companies and specialists
regarding prior authorization
Observation
Record Review
TECHNICAL
KNOWLEDGE IN
ECLINICALS
Navigates patient demographics, telephone encounters, and referral
orders proficiently
Able to send and receive faxes electronically
Records all actions taken on referrals in a way that others can
understand and reproduced
Understands circumstances which allow for addressing referrals and
when they should be left open
Locates and files records in appropriate areas of patient documents
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
EDUCATION
Participates in continuing education programs and completes all
mandatory programs annually
Completes departmental clinic competency evaluations including
annual competency testing
Education Review
PROFESSIONALISM
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
Self
Evaluation
Rating
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. COMMUNICATING WITH STATE AND PRIVATE INSURANCE: Include areas identified as
needing improvement as well as areas that exceed expectations
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4. TECHNICAL KNOWLEDGE IN ECLINICALS: Include areas identified as needing improvement as
well as areas that exceed expectations
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5. EDUCATION: Include areas identified as needing improvement as well as areas that exceed expectations
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6. PROFESSIONALISM: 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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