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Position Classification Description

Position Class Code / Title: A2018 / Pat Svcs Rep/Critical Care
Recruitment Tier: Tier 1
FLSA: Non-Exempt
Grade: 08

This is a description of a Staff Position Classification. It is not an announcement of a position opening. To view descriptions of current openings, please go to UNMJobs and Search Postings to view positions that are currently accepting applications.

The following statements are intended to describe, in broad terms, the general functions and responsibility levels characteristic of positions assigned to this classification. They should not be viewed as an exhaustive list of the specific duties and prerequisites applicable to individual positions that have been so classified.

Summary

Provides a range of administrative and clinical support services in support of specialized medical diagnostic studies and treatment plans undertaken in a critical care diagnostic and treatment setting. Performs all administrative aspects of patient intake protocol, schedules clinic appointments, examinations and tests, maintains physician schedules, coordinates referrals and authorizations, and provides standard patient education and instruction. Collects and maintains patient medical data and records, completes physician orders, and facilitates specialist care.

Duties and Responsibilities

  1. Receives, screens, interviews, and registers patients for clinics; performs patient check-in, collection of co-payments, and verification of appointment and information and directs patients to proper clinic area.
  2. Handles phone inquiries from patients and others; screens calls to ascertain nature and urgency of inquiry, refers callers as appropriate, and/or schedules appointments.
  3. Reviews patient admission records to ascertain insurance coverage and need for financial assistance, and counsels patients and families regarding financial issues; obtains insurance authorizations or initiates applications for public assistance, as appropriate.
  4. Verifies insurance coverage with third party payers, as appropriate; records patient demographic, insurance, and billing codes, researches missing information on intake forms, and obtains signatures and release forms.
  5. Responds as appropriate to inquiries from patients and third party payers regarding treatment, benefits, and billings; coordinates the resolution of related problems. solution of related problems and issues.
  6. Performs pre-clinic preparation, to include ordering tests, review of patient accounts for accuracy, and advance registration; provides instructions and directions to patients regarding diagnostic tests, procedures, and treatments.
  7. Arranges hospitalization for in-patient therapies and procedures; notifies nursing unit, completes relevant forms, and calls bed reservation.
  8. Performs data entry of laboratory studies, radiographic tests, and authorization requests, in compliance with physician directives.
  9. Submits and follows up on requests for authorization to specified health plans for scheduled ancillary testing or specialty care, in accordance with the guidelines of the patient's insurance provider.
  10. Provides day-to-day staff support as appropriate, to include preparation of documents, collection and verification of records, and maintenance of data on clinical activity; operates or oversees a multi-line switchboard.
  11. Performs cash balancing and documentation, and secures daily receipts; orders and maintains clinic inventory and supplies as required.
  12. Follows established departmental policies, procedures, and objectives, continuous quality improvement objectives, and safety, environmental, and/or infection control standards.
  13. Performs miscellaneous job-related duties as assigned.

Minimum Job Requirements

  • High school diploma or GED; at least 3 years of experience directly related to the duties and responsibilities specified.
  • Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year for year basis.

Knowledge, Skills and Abilities Required

  • Knowledge of cash management principles and/or procedures.
  • Working knowledge of operational protocols and administrative procedures within a complex clinical environment.
  • Knowledge of supplies, equipment, and/or services ordering and inventory control.
  • Knowledge of planning and scheduling techniques.
  • Working knowledge of patient registration and intake procedures and documentation.
  • Knowledge of related accreditation and certification requirements.
  • Ability to effectively interact and communicate with people in person and over the telephone.
  • Ability to maintain composure within a demanding, sometimes stressful, environment.
  • Ability to perform basic patient assessments and referrals.
  • Skill in preparing and maintaining patient records.
  • Working knowledge of medical insurance; claims procedures, authorization requirements, and documentation.
  • Ability to successfully communicate and interact with seriously ill patients and families on complex administrative matters.
  • Knowledge of patient care charts and patient histories.
  • Ability to follow complex and involved instructions concerning patient care coordination and administration.
  • Knowledge of medical billing procedures.
  • Ability to analyze complex information, and to define and solve problems.
  • Intermediate computer skills and the ability to multitask using various medical and office software programs.
  • Ability to interact effectively with licensed health care professionals and specialized skilled nursing staff.
  • Knowledge of the pre-certification requirements, procedures and documentation of third party medical insurance payers.
  • Knowledge of the nature and provisions of alternative health insurance plans.

Working Conditions and Physical Effort

  • Work is performed in an interior medical/clinical environment.
  • No or very limited physical effort required.
  • No or very limited exposure to physical risk.

The University of New Mexico provides all training required by OSHA to ensure employee safety.

Revised Date: 03/20/2017