CYNET_SYSTEMS_MAIN_LOGO.gif   PATIENT ACCESS REPRESENTATIVE SKILLS CHECKLIST
   NAME    
   LAST 4 OF SSN      
   DATE    
I hereby certify that ALL information I have provided to IMCS Group on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.  
Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.  
Proficiency Scale: 1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently

  
       
Rating Stars (Click) Administrative Duties 1 2 3 4  
Data Entry  
Medical Records - Entry  
Medical Records - Maintenance  
Electronic Medical Records - Entry  
Electronic Medical Records - Maintenance  
Gathers data and runs reports  
Patient Files - Set up, report and record  
Completion and filing/distribution of reports  
Schedules appointments/tests  
Takes, distributes and prioritizes messages  
Rating Stars (Click) Problem Solving 1 2 3 4  
Uses reason when dealing with emotional topics  
Rating Stars (Click) Customer Service 1 2 3 4  
Manages difficult or emotional customer situations  
Responds promptly to customer needs  
Responds to requests for service and assistance  
Rating Stars (Click) Interpersonal Skills 1 2 3 4  
Focuses on solving conflict  
Rating Stars (Click) Listens to others without interrupting 1 2 3 4  
Keeps emotions under control  
Rating Stars (Click) Remains open to others' ideas and tries new things 1 2 3 4  
Develops patient, physician and peer relationships  
Maintains/protects patient confidentiality  
Adheres to facility policies and procedures  
Adheres to OSHA, HIPPA, legal and ethical guidelines  
Adheres to quality protocol and standards  
Attends and participates in required meetings  
Schedules appointments, tests and treatments  
Responds to emergencies in a calm organized manner  
Understands/follows the reporting process acording to the chain of command  
Rating Stars (Click) Oral/Telephone Communication Skills 1 2 3 4  
Speaks clearly and persuasively in positive or negative situations  
Ability to manage multiple phone lines  
Communicates clearly and professionally  
Listens and gets clarifications  
Spanish Fluency  
Responds well to questions  
Rating Stars (Click) Written Communication 1 2 3 4  
Presents numerical data effectively  
Spanish Fluency  
Able to read and interpret written information  
Rating Stars (Click) Teamwork 1 2 3 4  
Balances team and individual responsibilities  
Exhibits objectivity and opennes to others' views  
Gives and welcomes feedback  
Contributes to building a positive team spirit  
Puts success of team above own interests  
Able to build morale and group commitments to goals and objectives  
Supports everyone to succeed  
Rating Stars (Click) Diversity 1 2 3 4  
Shows respect and sensitivity for cultural differences  
Rating Stars (Click) Ethics 1 2 3 4  
Treats people with respect  
Keeps commitments  
Inspires the trust of others  
Works with integrity  
Upholds organizational values  
Rating Stars (Click) Organizational Support 1 2 3 4  
Follows policies and procedures  
Completes administrative tasks correctly and on time  
Supports organization's goals and values  
Supports affirmative action and respects diversity  
Rating Stars (Click) Motivation 1 2 3 4  
Demonstrates persistence and overcomes obstacles  
Measures self against standard of excellence  
Rating Stars (Click) Planning/Organizing 1 2 3 4  
Uses time efficiently  
Rating Stars (Click) Professionalism 1 2 3 4  
Approaches others in a tactful manner  
Reacts well under pressure  
Treats others with respect and consideration regardless of their status or position  
Accepts responsibility for own actions  
Follows through on commitments  
Rating Stars (Click) Quality 1 2 3 4  
Meets productivity standards  
Completes work in timely manner  
Strives to increase productivity  
Works quickly  
Rating Stars (Click) Safety and Security 1 2 3 4  
Observes safety and security procedures  
Reports potentially unsafe conditions  
Uses equipment and materials properly  
Rating Stars (Click) Adaptability 1 2 3 4  
Adapts to changes in the work environment  
Able to deal with frequent change, delays or unexpected events  
Rating Stars (Click) Attendance/Punctuality 1 2 3 4  
Dependability  
Initiative  
Innovation  
Rating Stars (Click) Computer Skills 1 2 3 4  
Medic, Medic Soft  
Centricity  
Medical Manager  
HIS  
Word, Word Perfect  
Soft  
Windows  
IDX  
Meditech  
Rating Stars (Click) EMR 1 2 3 4  
Epic  
Cerner  
Eclipsys  
McKesson  
Meditech  
Other Computerized System  
Computerized Physician Order Entry  
Bar Coding for Medication Administration  
MY EXPERIENCE IS PRIMARILY IN:  
Unit No. of Years Unit No. of Years  
BURN POST PARTUM  
CRITICAL UNIT LABOR & DELIVERY  
PACU NEWBORN NURSERY  
NEUROLOGY LEVEL II NICU  
TELEMETRY LEVEL III NICU  
MEDICAL PICU  
SURGICAL  PEDIATRICS  
ONCOLOGY OB/GYN  
ORTHOPEDICS PSYCHIATRY  
OPERATING ROOM RRT  
EMERGENCY ROOM CRT  
TRAUMA CENTER LEVEL 1    
COMMUNITY ER    
RURAL ER    
Rating Stars (Click)  Age Specific Competencies 1 2 3 4  
Newborn/Neonatal (birth – 30 days)  
Infant (30 days-1 year)  
Toddler (1-3 years)  
Preschool (3-5 years)  
School Age Children (5-12 years)  
Adolescent (12-17 years)  
Young Adults (18-44 years)  
Middle Adults (45-64 years)  
Older Adults (>65 years)