Physical Requirements:
The following frequency definitions apply to all Physical Requirements unless otherwise noted:
Occasional: (0-1/3 of day , 0 - 2.5 hrs/day, 1 - 4 reps/hr)
Frequent: (1/3 -2/3 of day , 2.5 - 5.5 hrs/day, 5 -24 reps/hr)
Constant: (> 2/3rd of day , > 5.5 hrs/day, > 24 reps/hr)
NOTE: An asterisk (*) indicates that the item is an essential function.
Non-Material Handling
Standing - Remaining on one's feet in an upright position remaining stationary - N/A
Walking - Remaining upright on one's feet, and moving about - OCCASIONAL
Sitting* - Body remains in a seated position - CONSTANT
Stooping - To bend the body downward and forward by bending the spine at the waist - N/A
Bending - To flex the upper body forward - N/A
Twisting* - To rotate the upper body forward - OCCASIONAL
Climbing - To move the body in any direction on equipment or structures that do not include stairs or ladders - N/A
Ladders - To ascend and descend ladders - N/A
Stairs - To ascend and descend stairs - N/A
Kneeling - To move the body downwards and come to rest on both hands and both knees - N/A
Squatting - To move the body downwards by bending both knees - N/A
Crouching - To bend the body forward and downward by bending the spine and the legs - N/A
Crawling - To move the body forward or backwards on hands and knees - N/A
Reaching Horizontal* - To extend the arms and hands outward, remaining under shoulder height - CONSTANT
Reaching Overhead - To extend the arms and hands up and out over shoulder height - OCCASIONAL
Grasping* - Using functional gripping of the hand to handle an object - CONSTANT
Finger Manipulation* - To manipulate objects with the use of fingers - CONSTANT
Seeing* - Using visual feedback to accomplish a task or activity - CONSTANT
Hearing* - Using sound feedback to accomplish a task or activity - CONSTANT
Repetitive Upper Extremity Use* - Using the arms and/or hands continuously or more than 2/3 of the total time - CONSTANT
Repetitive Lower Extremity Use - Using the legs and/or feet continuously or more than 2/3 of the total time - N/A
Material Handling
Pushing - To exert a force upon an object in order to move it in a certain direction Pushing refers to moving an object away from the
person - N/A
Pulling - To exert a force upon an object in order to move it in a certain direction Pulling refers to moving an object towards the person

• N/A

Lift - Floor to Waist - N/A
Lift - Waist to shoulder - N/A
Lift - Shoulder to overhead - N/A
Carrying - To transport an object or article using the arms or hands (> 10 feet) - N/A
Environmental Factors
Working alone - OCCASIONAL
Working in cramped quarters - N/A
Constant interruptions - FREQUENT
Working with hands in water - N/A
Use of power tools - N/A
Working on ladders/scaffolding - N/A
Exposure to vibration - N/A
Exposure to dust - N/A
Exposure to noise (constant) - N/A
Exposure to electrical energy (outlets, etc) - N/A
Exposure to temperature changes (heat, cold, humidity), that require special clothing - N/A
Exposure to slippery walking surfaces - N/A
Exposure to solvents, grease, oils - CONSTANT
Exposure to radiant energy, ie computer terminal (more than 4 hours per shift)* - CONSTANT
Working with bloodborne pathogens - N/A
Cardiovascular Energy Requirements - Physical Demand
Physical Demand Met Level Examples of similar activity intensity
Sedentary to Light 0 - 3.5 Light house cleaning, washing dishes, serving food, food shopping, sitting, standing, computer work.
Medium 3.6 -6.3 House work (mopping, scrubbing), health club exercising, treadmill work, stretching, yoga, walk/run-play with children, aerobic class, dancing, carrying bucket/wood, auto body repair, shoveling snow, golf (carrying clubs).
Heavy to Very Heavy > 6.4 Calisthenics (push up, pull up, sit up, vigorous effort), carrying groceries upstairs, shoveling coal, bailing hay, fire fighting, sawing by hand, splitting wood.
As relates to this position:
Sedentary to Light* - CONSTANT
Medium - N/A
Heavy to Very Heavy - N/A
I. Specific Job Responsibilities (Essential Functions):
1. Schedules appointments for patients by phone when they call in following medical practice scheduling protocols. Utilizes time management and
customer service skills to facilitate phone calls with patient, staff, and others. Communicates calmly and clearly with patients about
appointments in all circumstances.
2. Maintains scheduling system to ensure records are accurate and complete and can be used to analyze patient/staffing patterns. Confirms that
updates (i.e., cancellations or additions) are input into the master schedule promptly. Stays up to date with system services to facilitate efficient
and timely patient access.
3. Obtains referrals, authorizations, and demographic information for patients. Verifies insurance information to maximize reimbursement with all
third party payers.
4. Communicates as needed with supervisor about any patient concerns/issues related to scheduling and/or system problems.
5. Analyzes situation and responds appropriately including when to elevate call to a clinical agent and/or supervisor. Performs other duties as
assigned.
II. Organizational Responsibilities:
1. Completed mandatory education, annual competencies and department specific education within established timeframes.
2. Completed annual employee health requirements within established timeframes.
3. Maintained license/certification, registration in good standing throughout fiscal year.
4. Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self. Identifies
and works to reduce potentially unsafe patient care or other safety practices.
5. Adheres to regulatory agency requirements, survey process and compliance.

• Please use the following to determine the rating for Section I and Section II:

If employee is rated "Meets" at least 7 of 10 in Sections I and II, their rating is "Meets".
If employee is rated "Does Not Meet" for 4 or more in Sections I and II, their rating is "Does Not Meet".
Based on the above, the rating for Section I and Section II is:
III. Job Behaviors:
1. “Sets the Stage” by using greetings/introductions when interacting with any customer or entering a patient room. Looks and acts like a
professional. Uses consistent phone etiquette. Helps people who look lost or confused. Keeps a clean and professional environment and work
space. Clarifies expectations and creates positive handoffs and positive lasting impressions.
2. Fosters a teamwork approach by respecting other members of the hospital team. Stays involved and informed of happenings within the
organizations. Creates win-win situations by helping others. Works to resolve conflicts and concerns in a constructive way and asks for
assistance in helpful ways.
3. Is the Owner: Takes responsibility for problems, issues or opportunities for improvement by initiating constructive review of concern rather
than negatively attacking an issue. Understands systems and processes and uses appropriate channels to address concerns when out of own
span of control. Demonstrates compassion and works beyond “own assignment” by seeing “big picture”.
4. Creates a Caring Environment by communicating in helpful ways. Always protects the confidentiality and dignity of patients and others.
Listens with empathy and understanding and provides options and choices.
5. Provides Great Explanations through user-friendly information and explanations (uses language others can understand). Makes sure people
know what they can and cannot expect and checks for understanding and agreement.

• Please use the following to determine the rating for Section III:

If employee is rated "Exceeds" for at least 3 of 5 AND is rated "Meets" for the remaining, their rating is "Exceeds".
If employee is rated "Exceeds" for less than 3 of 5 and "Meets" for the remaining, their rating is "Meets".
If employee is rated "Does Not Meet" for 2 or more, their rating is "Does Not Meet".
Based on the above, the rating for Section III is:
IV. Overall Performance Summary:
Based on the rating for combined Section I and II, and rating for Section III, please
select the overall rating for this evaluation period using the outline below.
Exceeds Expectations: Demonstrates exceptional behaviors and exceeds position requirements. Willingly accepts additional responsibilities.
Demonstrates expertise in relevant skills and utilizes knowledge to support overall department/organizational goals
Defined as:
Employee rates "Meets Expectations" for 10 out of 10 in Sections I and II
Employee rates "Exceeds Expectations" in Section III
Meets Expectations: Achieves and may occasionally exceed performance expectations while demonstrating expected behaviors.
Defined as:
Employee rates "Meets Expectations" in Sections I and II
Employee rates "Meets Expectations" in Section III
Does Not Meet Expectations: Performance improvement is needed in one or more areas of expected behaviors or job results.
Defined as:
Employee rates "Does Not Meet" for their overall rating for Section I and Section II OR for Section III

• Please select the appropriate Overall Performance Summary rating for

the review:
Value Equation:
As an organization we prioritize the delivery of a valuable offering to those we serve. For Butler Health System, that means delivering the
highest quality of service at a reasonable cost all the while exceeding expectations related to the level of service.
Please describe how you have contributed to and supported the BHS Value Equation:
Development and Training:
Employee future development goals/objectives:
Reviewer recommendation for further development and training for purposes of preparing for additional responsibilities or for the
improvement of current job performance:
Ongoing Counseling for Performance Behaviors:
Reviewer: Please indicate whether employee was disciplined during the course of this review period and if so indicate at which
level and the reason(s).
Select below:
Please select level:
If disciplined during this review period, indicate reason: (note: if multiple reasons apply, please select “Other”)
Note: If suspended for any reason during the fiscal year, employee will not be eligible for any increase.
Education:
Employee to complete the following:
Highest Level of Education Completed:
Course of Study/Major for Highest Level of Education Completed:
License(s)/Certification(s)/Registration(s) currently held:
Acknowledgement:
Review Acknowledgement: My signature indicates that I have had an opportunity to review and discuss my performance review
with my reviewer. I further acknowledge that my signature indicates that I have reviewed the content of the performance review,
not whether I agree or disagree with it.
Acknowledgement of Code of Conduct: My signature below indicates that I acknowledge that I have received and have read a
copy of the Butler Health System Code of Conduct Policy. I know that additional copies are available to me through the company
intranet or that I may also receive a copy by requesting one from my manager, the Human Resources Department, or from the
Corporate Compliance Officer. I agree to abide by this policy and if there is anything I don’t understand I will contact my
manager or the Corporate Compliance Officer at Ext. 5924 for clarification. I also verify that I am not aware of any conduct or
action on the part of any Butler Health System or Butler Memorial Hospital employee, staff member or supplier of goods or
services that I reasonably believe is or could be a violation of the Butler Health System Code of Conduct. If I wish to report any
concern or action, I may do so by placing a call to the Compliance Hotline by dialing 1-855-661-0965.