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Position Classification Description

Position Class Code / Title: A5039 / Coord,Provider Enrollment
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 the day-to-day administration of the University of New Mexico Health Sciences Center's provider Medicare and Medicaid enrollment program, ensuring that all existing and new physicians and other billing health care providers in the HSC system are enrolled in compliance with all affiliation and participation requirements, as well as regulatory and internal policy requirements.

Duties and Responsibilities

  1. Monitors and coordinates the Medicare/Medicaid application approval process (including out of state) for all new HSC physicians and credentialed mid-level health care professionals.
  2. Monitors data collection, and reviews and evaluates quality of all provider information received through the application process; acquires additional information as necessary, and verifies documentation in accordance with established policies and procedures.
  3. Identifies and reports any situations or issues regarding new or current providers that may have potentially adverse implications with respect to Medicare/Medicaid reimbursements; recommends solutions and/or courses of action to be taken and coordinates action with interested departments.
  4. Coordinates the administration of processes and procedures designed to ensure compliance with established financial and operating objectives, University policies, and legal requirements as they relate to provider professional billing for Medicare/Medicaid.
  5. Maintains and ensures the on-going accuracy and organization of aspects of the billing system data dictionaries as they relate to Medicare/Medicaid billing; maintains and disseminates procedures and materials to ensure accurate and efficient data collection.
  6. Prepares data summaries and reports relating to Medicare/Medicaid for clinical departments, administrators, and other interested constituencies, as appropriate.
  7. Maintains currency of knowledge on Medicare/Medicaid provider requirements in all states Nationally; ensures that provider initial certification and recertifications for Medicare/Medicaid are continually up to date with respects to out of state requirements.
  8. Coordinates the processing and data entry of new physician applications for Medicare/Medicaid billing purposes, and follows up as necessary to ensure accuracy and compliance with all applicable University policies and procedures.
  9. Attends meetings relative to the physician approval process as requested; provides guidance and support, and serves as a resource on related process issues as appropriate.
  10. Acts as a primary point of contact for all internal and external constituencies on day-to-day administrative matters associated with the Medicare/Medicaid participation process; troubleshoots and resolves problems as they arise.
  11. Facilitates and assists with internal and external audits as appropriate.
  12. 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 develop and maintain recordkeeping systems and procedures.
  • Working knowledge and understanding of all rules, regulations, policies, and procedures with regard to health care professional billing under Medicare/Medicaid.
  • Ability to communicate effectively, both orally and in writing.
  • Analytical, evaluative, and critical thinking skills.
  • Knowledge and understanding of electronic data collection and data management systems and procedures.
  • Ability to prioritize and manage a demanding workload.
  • Ability to make administrative/procedural decisions and judgments.
  • Working familiarity with Medicare/Medicaid provider billing requirements in all states of the union.
  • Knowledge of UNM medical practice billing procedures and systems as they relate to Medicare/Medicaid.
  • Skill in the use and administration of specialized electronic medical billing applications.
  • Ability to perform research and prepare reports and summaries based on research data.
  • Strong interpersonal skills and ability to work effectively at all levels in a collaborative team environment.

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