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G.1 Job Descriptions and Training Materials Laboratory Coordinator: The Laboratory Coordinator receives lab results and x-rays from other medical facilities and interprets them as well as those performed in-house, and disperses them to the proper providers. Upon interpreting results, he or she calls patients’ parents with the results and advises them regarding check-ups, repeating tests, and changes in medication. He or she maintains the lab inventory and equipment as well, ensuring that all machinery is in compliance with CLIA standards and that all supplies are in stock. This position also requires knowledge and execution of all allergy testing, ensuring that supplies are in-stock and that the staff are trained and present when testing is made available to the staff. Position Requirements: Extensive technological knowledge including: o Skill in typing o Assembling and interpreting spreadsheets o Understanding internet ordering systems o Ability to learn requirements for maintenance of specialized machinery Education o High school diploma or GED o Higher education in medicine such as LPN or MOA certification Medical background and knowledge including: o Interpreting various labs and x-rays o Answering patient questions involving medication and circumstances requiring followup appointments Inventory management experience Training Schedule and Implementation The Laboratory Coordinator is trained regarding practical procedures and clinic policy through pairing with the Care Team Coordinator. This relationship lasts as long as the Coordinator deems necessary, and training is targeted for completion no less than two weeks after employment and no more than one month after employment. The trainee and CTC walk through the LPN Training Checklist and the Coordinator addresses and instructs on each topic; after two weeks the trainee is evaluated and self-evaluates to determine further training and ensure development. This evaluation is then given 90 days after hiring to ensure retention and execution of the training, and then is given annually to monitor progress and make necessary changes to the curriculum and policies. Referral Coordinator: The Referral Coordinator receives information from providers and directs it to the appropriate specialist. He or she verifies that each specialist is covered by the patient’s insurance and obtains the appropriate authorization from the patient’s insurance and communicates authorization with the specialist’s practice. The coordinator makes appointments for our patients, communicates the needs of the patient to the specialist, and informs the patient of the appointment and any requirements before the appointment. When the appointment should be made by the parent, the Referral Coordinator gives all necessary information to the parent in order to make the appointment. Position Requirements Technological knowledge including: o Skill in typing o Understanding of communications including fax and email o Proficiency in eClinicals or ability to learn new technological systems o Understanding of state and private insurance web sites Communication skills regarding phone calls: o Polite and courteous attitude o Organization regarding returned phone calls, answering voicemails, and following up on all calls Training Schedule and Implementation The Referral Coordinator is trained regarding practical procedures and clinic policy through pairing with the current or previous Referral Coordinator, or the Care Team Coordinator when there is no Referral Coordinator in place. This relationship lasts as long as the Coordinator deems necessary, and training is targeted for completion no less than two weeks after employment and no more than one month after employment. The trainee and Coordinator walk through the Referral Coordinator Training Checklist and the Coordinator addresses and instructs on each topic; after two weeks the trainee is evaluated and self-evaluates to determine further training and ensure development. This evaluation is then given 90 days after hiring to ensure retention and execution of the training, and then is given annually to monitor progress and make necessary changes to the curriculum and policies. LPN or MOA The LPN/MOA assist in coordinating and providing quality patient-focused care in a physician’s clinic. The LPN/MOA assists physicians with all procedures, coordinates activities to maintain adherence to daily Clinic schedule, communicates effectively with patients, family, physician and staff, monitors and coordinates the use of supplies and equipment, practices within regulatory guidelines, and promotes teamwork and customer/patient satisfaction. Position Requirements Education: o High school diploma or GED o Graduate of an accredited school of Medical Assisting or Practical Nursing with current diploma or valid GA LPN license Ability to read and communicate effectively through oral and written correspondence, to demonstrate problemsolving skills, and interpret a variety of instruction. Ability to interpret CLIA, HIPPA, and OSHA standards and regulatory body’s standards as they relate to medical practice in ambulatory setting Current BCLS, knowledge of medical terminology, computer experience. Able to maintain emotional stability Must be in good physical condition to need the demands of an active position: o Extensive walking or standing o Lifting and positioning of patients o Moving stretcher, wheelchairs, carts and equipment o Finger/hand manipulation, visual/mental concentration on instruments, observation or and rapid reaction Training Schedule and Implementation All LPNs and MOAs are trained regarding practical procedures and clinic policy through pairing with the Nursing Staff Coach, or the Care Team Coordinator when there is Coach in place. This relationship lasts as long as the Coach deems necessary, and training is targeted for completion no less than two weeks after employment and no more than one month after employment. The trainee and Coach walk through the LPN/MOA Training Checklist and the Coach addresses and instructs on each topic; after two weeks the trainee is evaluated and self-evaluates to determine further training and ensure development. This evaluation is then given 90 days after hiring to ensure retention and execution of the training, and then is given annually to monitor progress and make necessary changes to the curriculum and policies. Front Office Clerk/Patient Representative Under the direct supervision of the Nursing Supervisor and Office Manager, the Front Office Clerk/Patient Representative will assist in coordinating and providing quality patient-focused care in the clinic. He or she will be responsible for identified business affair functions within the clinic and duties including, but not limited to: receiving and greeting all patients and visitors, preregistration, registration, and maintenance of the patient’s records, updating patient information at each office visit, verifying insurance coverage, collecting co-payments and other money due, balancing receipts and Close of Day report, ordering supplies and forms for the front office area, and communicating effectively with patients and staff. He or she must practice within clinic guidelines, promote teamwork, and seek patient satisfaction. He or she will be expected to uphold patient confidentiality at all times, according to HIPAA guidelines. Position Requirements A high school diploma or equivalent GED Ability to read and communicate effectively through oral and written correspondence Technological skills including typing proficiency and ability to learn new systems Ability to maintain emotional stability under stress Ability to multi-task Math proficiency regarding balancing of accounts Inventory management skills Ability to function as part of a team Training Schedule and Implementation Each member of the Front Office Staff is trained regarding practical procedures and clinic policy through pairing with the front office Employee Coach. This relationship lasts as long as the Coach deems necessary, and training is targeted for completion no less than two weeks after employment and no more than one month after employment. The trainee and Coach walk through the Front Office Staff Checklist and the Coach addresses and instructs on each topic; after two weeks the trainee is evaluated and self-evaluates to determine further training and ensure development. This evaluation is then given 90 days after hiring to ensure retention and execution of the training, and then is given annually to monitor progress and make necessary changes to the curriculum. Patient Coach/Advocate In conjunction with the Care Team, the Patient Coach stands between the patient and provider in order to give patients informed answers to their questions while allowing the health care providers to spend more time treating patients and less time assessing issues. He or she handles all medication refills and refill requests, facilitating communication between patient, provider, and pharmacy. This includes fielding calls regarding prescription renewal for supporting services, therapies, and refills on WIC prescriptions for formula renewals, and handling all prior authorizations required for medications: submitting the necessary paperwork and following through with all calls to insurance companies. He or she also handles all calls from parents or pharmacies regarding any medication substitutions for prescriptions that insurance will not cover, and assists the physicians in providing medication samples to patients. He or she assists parents in applying for patient assistance programs for medications that they cannot afford or that insurance companies will not cover. The Patient Coach handles all questions, appointments, and prescriptions for vulnerable populations. This includes counseling parents regarding ADD, ADHD, depression, anger, and behavior disorders, talking with physicians regarding the issues, and relaying any information or recommendations to the parents. He or she schedules all of the consult appointments for these diagnoses, as well. The Patient Coach also assists patients in obtaining necessary durable medical equipment, and assists home health nurses in obtaining equipment, medications, and services for our patients. He or she receives and addresses calls regarding patient complaints, checks all faxes into the office on internal and accessory fax lines, assists with relaying physician recommendations to parents regarding lab and x-ray results, assists physicians in coordinating their schedules to accommodate necessary meetings in and outside of the clinic, and fields all calls from other physicians’ offices: relaying messages to the physician or connecting the physician to the caller when necessary. Position Requirements: Education: o High school diploma or GED o Graduate of an accredited school of Medical Assisting or Practical Nursing with current diploma or valid GA LPN license Excellent skill in oral and written correspondence, ability to demonstrate problem-solving skills and interpret a variety of instruction. Ability to interpret CLIA, HIPPA, and OSHA standards and regulatory body’s standards as they relate to medical practice in ambulatory setting Current BCLS, knowledge of medical terminology, computer experience. Able to maintain emotional stability under stress Medical background and knowledge including: o Interpreting various labs and x-rays o Answering patient questions involving medication and circumstances requiring followup appointments Ability to address patient questions in a respectful, knowledgeable, and thorough way Proficiency under circumstances which require extreme multi-tasking Training Schedule and Implementation The Patient Coach/Advocate is trained regarding practical procedures and clinic policy through pairing with the Care Team Coordinator or the previous Patient Coach/Advocate. This relationship lasts as long as the CTC deems necessary, and training is targeted for completion no less than two weeks after employment and no more than one month after employment. The trainee and CTC walk through the Patient Advocate Checklist and the CTC addresses and instructs on each topic; after two weeks the trainee is evaluated and self-evaluates to determine further training and ensure development. This evaluation is then given 90 days after hiring to ensure retention and execution of the training, and then is given annually to monitor progress and make necessary changes to the curriculum. Care Team Coordinator The Care Team Coordinator (CTC) manages day to day operations and procedures in the front office. He or she design and implements office policies, establishes standard protocols and procedures, organizes office operations, and supervises nursing and office staff. This involves evaluating staff performance and coaching staff when needed. He or she assigns duties for all office and nursing staff, prepares time sheets and processes payroll, and is responsible for making sure the nursing staff is updated with all policies and guidelines. The CTC maintains any physician and mid-level personnel files and handles all CLIA and state regulations for all clinics. This person recruits, interviews, selects, and schedules all nursing and office staff and trains them upon employment, and is responsible for ensuring the qualifications and training of the nursing staff. He or she records and maintains any employee files including physicians, PA’s, NP’s, nursing staff, and office staff, ensuring that personnel files are up-to-date and secure. This person also formulates work schedules for nursing and front office staff and assigns call schedules for providers at local hospitals, plans office staff meetings and any training for HIPPA or overall safety, and assists physicians in coordination of their schedules to accommodate necessary meetings. The CTC stands between the patient and provider on quality issues, receiving and addressing all patient complaints. This person assists the physicians with any patient or employee issues that arise in the office, and returns patient phone calls regarding concerns or complaints, and makes necessary changes to policies related to those complaints. The CTC maintains clinic inventory, reviewing and approving supply requisitions and maintaining all office and medical equipment. He or she maintains, counts, and records all vaccines given in the office and balances state-funded vaccines, and ensures that patient areas and rooms are maintained in hygienic and comfortable states. This person monitors all lab results entered, reviews charts to ensure correct information, and handles all chart reviews for state- and privately-funded insurance. Position Requirements: Education: o High school diploma or GED o Graduate of an accredited school of Medical Assisting or Practical Nursing with current diploma or valid GA LPN license Excellent skill in oral and written correspondence, ability to demonstrate problem-solving skills and interpret a variety of instruction. Ability to interpret CLIA, HIPPA, and OSHA standards and regulatory body’s standards as they relate to medical practice in ambulatory setting Current BCLS, knowledge of medical terminology, computer experience. Able to maintain emotional stability under stress Medical background and knowledge including: o Interpreting various labs and x-rays o Answering patient questions involving medication and circumstances requiring followup appointments Ability to address patient questions in a respectful, knowledgeable, and thorough way Proficiency under circumstances which require extreme multi-tasking Training Schedule and Implementation The Care Team Coordinator is trained regarding practical procedures and clinic policy through pairing with the previous Care Team Coordinator or a combination of the Patient Coach and the Office Manager. This relationship lasts as long as the Office Manager deems necessary, and training is targeted for completion no less than two weeks after employment and no more than one month after employment. The trainee and CTC walk through the Care Team Coordinator Checklist and the CTC addresses and instructs on each topic; after two weeks the trainee is evaluated and self-evaluates to determine further training and ensure development. This evaluation is then given 90 days after hiring to ensure retention and execution of the training, and then is given annually to monitor progress and make necessary changes to the curriculum. Health Plan Coordinator The Health Plan Coordinator communicates between the practice and all state and privately owned insurance companies. He or she creates and processes all medical insurance claims, handles rejections from Clearinghouse, reviews Explanations of Benefits received from insurance companies and investigates reasons for denial, and sends claims electronically through Clearinghouse and on paper using the CMS 1500 form. He or she corrects ICD-9 and CPT codes denied due to incorrect coding, prints AR reports quarterly in order to review aging accounts, and answers patients’ insurance questions over the phone or face-to-face. Position Requirements Education: high school diploma or equivalent GED Excellent skill in oral and written correspondence, ability to demonstrate problem-solving skills and interpret a variety of instruction Ability to address patient questions in a respectful, knowledgeable, and thorough way Skills in math and accounting related to balancing of accounts and data input Technological skills including typing proficiency and ability to learn new systems Understanding of state and private insurance web sites Training Schedule and Implementation The Health Plan Coordinator is trained regarding practical procedures and clinic policy through pairing with the Office Manager. This relationship lasts as long as the Manager deems necessary, and training is targeted for completion no less than two weeks after employment and no more than one month after employment. The trainee and Coach walk through the Health Plan Coordinator Checklist and the Office Manager addresses and instructs on each topic; after two weeks the trainee is evaluated and selfevaluates to determine further training and ensure development. This evaluation is then given 90 days after hiring to ensure retention and execution of the training, and then is given annually to monitor progress and make necessary changes to the curriculum. G.2 Communication Schedule and Structure All Healthcare Providers meet every two weeks to discuss common illnesses and treatments, difficulties with clinic policies, and new policies and incentives. These meetings are organized and executed by Dr. Joyave or his appointed substitute, and occur according to his determined Provider Meeting Agenda. The nursing staff and front office staff both meet once per month, and these meetings are organized and executed by the Care Team Coordinator. The purpose of these meetings is to review pertinent clinic policy, address common patient complaints or needs, and to gain feedback on clinic policies. The meetings occur based upon the Care Team Coordinator’s Agenda. The entire staff meets once per quarter, and the purpose of these meetings is to address broad customer needs and complaints, introduce new policies, and to remind staff of the clinic’s seasonal and overall goals. These meetings are organized by the Office Manager, Care Team Coordinator, and Dr. Joyave and follow the Staff Meeting Agenda set forth by that team. G.3 Standing Orders Standing Order for Patients with Asthma: Each patient of AGC Pediatrics with a diagnosis of asthma shall be evaluated of their condition on a semi-annual basis. This evaluation will include Spirometry Testing and a review of medications, as well as the procedures marked out in this protocol. All of these patients will be flagged in eClinicals to alert front office and nursing staff of their diagnosis. At each semi-annual evaluation the patient will receive a questionnaire to complete while awaiting the provider, the parent will receive the Parent Questionnaire, and an “Asthma Emergency Plan” and “Student Asthma Action Plan” will be attached to the patient’s chart at each semi-annual visit. These will be completed by patient and provider during the visit. In order to assist in providing quality care to our patients, a Peak Flow Test will be administered to all patients with a diagnosis of asthma. This test will be administered at the time of triage. Peak Flow Procedure: 1. 2. 3. 4. Record patient height Have patient in standing position Hold peak flow device in hand, careful not to restrict the movement of scale indicator Breathe in as deeply as possible G.4 5. 6. 7. 8. Seal lips around the mouthpiece Blow into the device as hard and fast as possible Repeat steps 2 through 6 for a total of 3 times Record all 3 readings, careful to label them 1, 2, and 3 Coordination of Patient Care Patient care as outlined in G.4 is handled by a team of four: the Care Team Coordinator oversees the work of the Laboratory Coordinator, the Referral Coordinator, and the Health Plan Coordinator to maintain efficient maintenance of patient needs. The curriculum outlined in G.4 is highlighted in the job descriptions of those personnel. G.5 Patient Coaching All patient coaching is assigned to the Care Team Coordinator and the Patient Advocate. Those aspects of their job descriptions are highlighted above. G.6 Population Management Population Management falls under the scope of the Patient Advocate, and those aspects of the Advocate’s job description are highlighted above. G.7 Treatment of Vulnerable Populations Vulnerable Patient Population Management falls under the scope of the Patient Advocate, and those aspects of the Advocate’s job description are highlighted above. G.8 Practice Evaluation