Smile, file and dial

~Office managers play an increasingly important role in running a doctor's office

Wanted: Office manager for busy doctor's office. Must be computer literate, able to answer multiple phone lines, speak concise and clear. Smile, file and communicate well with others. Must have experience dealing with insurance companies and possess knowledge of local, state and federal rules and regulations.

A doctor's office manager oversees the business operations of a medical practice. In a group practice, the office manager supervises the work of other administrative staff such as the medical receptionist, medical records technician and biller. In smaller offices, the manager may handle all or most of the administrative duties.

Pam Clark-Blackburn is office manager at George Medical Office in Cape Girardeau. It is staffed by one physician -- Dr. Robert George -- and several nurses. Clark-Blackburn says it's considered a small office, even though there are about 11,000 active patient files, and files are considered active if the patient visits at least once every three years.

Clark-Blackburn said managing the office includes a wide range of responsibilities such as training staff, working with vendors who sell equipment and supplies, contracting for removal of medical waste, ensuring compliance with various regulatory agencies, and renewing any licenses required for the personnel and office.

"Health care is a highly regulated industry, and much of the attention of the office manager is directed toward ensuring compliance, and that means a ton of paperwork," said Clark-Blackburn. "Besides being the manager, I'm also the receptionist and the secretary.

"We have the doctor who does the doctoring, the nurses do the nursing and I do everything else like the billing, the coding, the correspondence, the training and all the typing."

Clark-Blackburn said the computer age has doubled the paper workload in her office. The office manager for 10 years, she said legal forms that used to be half a page to one page long are now three or four pages long. She said anything that has to do with state or federal regulations often requires long forms and a follow-up letter by the doctor.

"I type all of that. It's getting worse. The bureaucracy is getting bigger and bigger," she said.

Clark-Blackburn said she operates all the computers and other necessary records-keeping equipment, but she also maintains hand-written files as backup because computers fail and the electricity could go out.

"None of our appointments go into the computer. They are all put in a physical book because too many times I call other doctors' offices about patient referrals and I'm told to call back later because their computer is down," she said.

Her job as office manager can be compared to being a bartender -- she has to listen to a lot of people.

"I hear their life stories. I hear every complaint they have. I hear everything before the doctor and nurses do. Some patients call and they don't want to get off the phone."

Clark-Blackburn said her job requires her to maintain a cordial and friendly attitude toward patients, who can often be very disagreeable. She said some patients want appointments when there are no openings and some want refills phoned into pharmacies when a doctor's visit is required.

A doctor could not maintain an office without an office manager, said Clark-Blackburn. And she offered proof.

"If I can't get in because of bad weather, the doctor locks the office and goes home. He cannot handle it himself, and he'll tell you that. He can't handle the people, the paperwork and the phones. It's too overwhelming."

Tom Weber is office manager/administrator at Orthopaedic Associates in Cape Girardeau. There are nine doctors there and each has his own support staff, but Weber is accountable for the overall operations of the group practice.

"We have a lot of employees here. I counsel staff members and can get them further training to improve their performance if necessary," Weber said. "I give the staff the tools they need to do a good job. It's really a team effort."

Weber said he hires and trains employees. He also monitors collections of money due, security of medical records and compliance with governmental regulations.

"There are layers of paperwork to deal with," he said. "Compliance activities are becoming more difficult because the federal government keeps giving us a lot of unfunded mandates that leads to increased costs."

Weber said the medical group has a business manager and an IT (information technology) director, who take some of the workload off him while he strives to help control costs, build efficiencies and maintain a high quality of care.

"The biggest challenge we face is declining reimbursement," he said. "We face increasing operating costs while reimbursement is declining. Storing and maintaining medical records is becoming increasing electronic, and we have to comply with increased security rules."

Weber said he is in charge of the oversight for collections and finances, security and compliance, ordering supplies and contracting for waste removal. He said as administrator, he has to be aware of all aspects of the operation of the group practice.