Clerical Eval Form

MARCUS A. EAST, M.D.

JOHN G. DODD, D.O.

RYAN W. LAPOUR, M.D.

ADAM T. SHUPE, O.D.

CLERICAL SKILL EVALUATION

Employee:

Hire Date:

Supervisor:

Review Date:

Rating Key

Proficient : expert, highly skilled, a thorough competence derived from training and practice.
Able to train others.

Excellent : extremely good; outstanding.
Able to work independently.

Satisfactory : acceptable; fulfilling expectations or needs; may need additional training or practice to achieve excellent rating.

Needs Training : new to skill or new employee.
Not yet trained on skill.

Skill Set

Rating

Goal

Due Date

Archiving / Scanning Records

Authorizations

Benefit Eligibility

Charge Posting / Online

Check-In Patients

Check-Out Desk

Electronic Billing

EMA Data Entry

Insurance Look-Up

Insurance Verification

Insurance Payment Posting

Interpreters

Investigate Denied Claims

New Patient Packets

No-Show Patients

Process Refunds

Pulling Charts

Recalls

Recording Obits

Referrals / Tracking

Running Reports Scheduling

Skill Set

Rating

Goal

Due Date

Scheduling

Sorting Mail

Taking Payments

Templating Schedule

Professional Training

Administrative Assistant

Appointment Coordinator

Bookkeeper - Patient Accounts

Certified Medical Billing Coder

Medical Billing Specialist

Medical Records

Other:

Training Comments

Supervisor / Administrator Comments

Employee Comments

By signing below I acknowledge the evaluation and agree to the goal and date requirements(s) listed above.

Employee Signature:

Date:

Supervisor / Administrator Signature:

Date: