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Position Classification Description

Position Class Code / Title: A5038 / Coord,Health Plan Data Svcs
Recruitment Tier: Tier 1
FLSA: Non-Exempt
Grade: 10

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

Coordinates information and problem resolution between contracted managed health care plans, university medical staff, and patients. Administers, coordinates, and communicates data changes on behalf of UNMH Clinical Contract Services for University Physician Associates, various departments within the School of Medicine, TriWest, LoboCare, etc., and assists with marketing and public relations, special events, and/or outreach activities, as appropriate.

Duties and Responsibilities

  1. Serves as a data collection and information resource to university health care providers, administrative staff, managed health care plan staff, contracted managed health care plan staff, and subscribers in order to ensure quality customer service and to optimize healtcare service reimbursement.
  2. Coordinates and/or participates in the development of provider directories, information packets, orientations, and in-service training for physicians and office staff.
  3. Maintains currency, quality, and accuracy of published practitioner data; gathers, analyzes, and evaluates recommended additions, deletions, modifications, and/or clarifications to data and makes changes accordingly.
  4. Coordinates regular internal data quality review checks and controls to ensure a high level of data integrity and accuracy.
  5. Compiles, edits, and prepares final text for publication; plans layout, arranges sequence of data, and coordinates the preparation and placement of data as appropriate.
  6. Develops and maintains statistical data for managed health care organizations: provides scheduled and special reports designed to optimize reimbursement for services.
  7. Responds to patient and provider inquiries by researching and resolving problems related to the status of health care providers.
  8. Facilitates and supports the daily operations of the HSC Clinical Contract Services function, to include University Physician Associates, various departments within the School of Medicine, TriWest, and LoboCare, in the areas of database design and management, forms and directories design, and liaison with third party providers.
  9. Assists in the development of marketing materials, as appropriate.
  10. Represents the university at community meetings and health fairs; assists with development of a provider directory.
  11. Performs miscellaneous job-related duties as assigned.

Minimum Job Requirements

  • High school diploma or GED; at least 5 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

  • Ability to resolve customer complaints and concerns.
  • Ability to develop and deliver presentations.
  • Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
  • Knowledge of editorial and publications processes, systems, and procedures.
  • Ability to gather and analyze statistical data and generate reports.
  • Sound working knowledge of data entry and integrity gained in a multi-leveled database environment.
  • Ability to communicate effectively, both orally and in writing.
  • Ability to analyze and solve problems.
  • Knowledge of local and national issues and trends in collection and validation of managed care and health care practitioner data.
  • Knowledge and understanding of laws, regulations, and documentation requirements for the management and reporting of medical credentialing and related information.
  • Knowledge of the administrative procedures and data requirements of contracted health plans.

Working Conditions and Physical Effort

  • No or very limited physical effort required.
  • No or very limited exposure to physical risk.
  • Work is normally performed in a typical interior/office work environment.

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

Revised Date: 03/20/2017