Application form



Experience,Knowledge and Skill

High SchoolDiploma; One year of previous experience in healthcare field or customerservice required, experience in healthcare admissions, registration, or billingpreferred. College degree can be substituted for experience. Must completemedical terminology course within first year, unless previously completed.Prefer Certified Healthcare Access Associate (CHAA) .

Specialized orTechnical Education Required

MedicalTerminology desired; ability to communicate over the telephone; excellentcustomer service skills. Must be able to interpret complex documents related toinsurance benefits. Must be able to read and understand physician's referrals.Requires judgement to accurately establish patient identity, assign insuranceinformation according to payer and facility guidelines, associate orders withscheduled services. 3. Intermediate computer skills required; ability tooperate a computer using Word, Excel, and email, fax machines, printers, andcopiers.

Manual orPhysical Skill Required

Must haveconsiderable hand-eye coordination to operate a computer. Must be able to sitor stand for long periods of time. Must be able to bend or squat to patient'slevel. Must be able to lift and carry supplies to department and to equipment(example: reams of paper to copiers/fax machines).

Physical EffortsRequired

Strength: LightPush: Occasionally Pull: Occasionally Carry: Occasionally Lift: OccasionallySit: Constantly Stand: Occasionally Walk: Occasionally

Personal Information

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Referral Information

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Placement Information

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High School

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Graduate School

Vocational School/ Other

Certifications / Licenses

License 1

License 2

License 3

License 4

Skills & Qualifications

Employment History

Current Employer

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Previous Employer 2


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Reference 1

Reference 2

Reference 3

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