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Position Classification Description

Position Class Code / Title: B0009 / Med Claims Rep
Recruitment Tier: Tier 1
FLSA: Non-Exempt
Grade: 06

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

Researches and analyzes delinquent third-party payer claims, determines reimbursement problems, and adjusts and resubmits claims.

Duties and Responsibilities

  1. Researches and analyzes third-party payor claims such as Medicare, Medicaid, Tricare, Managed Care, Workers Compensation, Indian Health Service, and varous commercial insurance; verifies patient eligibility, adjusts and resubmits claims.
  2. Researches and prepares billings for initial electronic claims submissions.
  3. May teach, train, and guide other personnel in claim preparation.
  4. Responds by telephone or correspondence to inquiries from patients/third party payers; explains insurance coverage to patients, researches problems, and corrects errors.
  5. Posts and receipts payments from patients and third party payers and reconciles input to ledgers and reports.
  6. Maintains statistical data and records; may prepare regularly scheduled or special reports on medical claims.
  7. May perform data entry, answer telephones, and assist with walk-in inquiries.
  8. Follows established departmental policies, procedures, and objectives, continuous quality improvement objectives, and safety, environmental, and/or infection control standards.
  9. Ensures strict confidentiality of financial records.
  10. Performs miscellaneous job-related duties as assigned.

Minimum Job Requirements

  • High school diploma or GED; at least 1 year 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 maintain quality, safety, and/or infection control standards.
  • Knowledge of medical claims procedures and documentation.
  • Ability to communicate effectively, both orally and in writing.
  • Knowledge of related accreditation and certification requirements.
  • Ability to use independent judgment and to manage and impart confidential information.
  • Knowledge of data management techniques.
  • Knowledge of medical billing procedures.
  • Knowledge of the precertification requirements, procedures and documentation of third party medical insurance payors.

Distinguishing Characteristics

    Position requires: a) researching and analyzing third-party payor claims; b) preparing and billing reimbursement claims; c) following established policies and procedures for the handling and safeguarding of confidential files and records; and d) maintaining records and preparing reports on medical claims.

Conditions of Employment

  • This position is represented by a labor union and is subject to the terms and conditions of the CWA Collective Bargaining Agreement.

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