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Position Classification Description

Position Class Code / Title: B3041 / Medical Practice Specialist,Sr
Recruitment Tier: Tier 1
FLSA: Exempt
Grade: 14

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

Plans, oversees, and monitors revenue-generating operations and systems of a major, multi-divisional clinical department within the Health Sciences Center. Develops and implements business strategies, policies, protocols, and systems that improve practice productivity, efficiency and customer service, and which support the enhancement of revenue. Monitors and oversees compliance with all applicable federal and state laws, regulations, and guidelines dealing with the conduct of a medical practice.

Duties and Responsibilities

  1. Plans, monitors, and quality-controls the performance of the clinical revenue-generating operations of the department, to include oversight of the performance of agents of the department; develops and implements appropriate operating benchmarks and standards.
  2. Performs complex and comprehensive financial and operating analyses to be used directly in senior management decision making; gathers clinical practice data from a wide variety of internal and external sources.
  3. Participates in strategic business planning for the department; researches new clinical practice opportunities, and makes recommendations to management regarding financial feasibility.
  4. Develops, implements, administers, and evaluates the departments annual clinical revenue action plan.
  5. Monitors and evaluates the provision of patient services within the practice, to include all operations affecting billing and provider productivity; interacts with and guides clinical managers in the enhancement of operating efficiency and improvement of responsiveness to patients.
  6. Oversees and evaluates the department's billing operations to ensure compliance with appropriate procedures and applicable laws, regulations, and policies; trains and updates physicians and staff on proper billing and coding practices, and recommends remedial action as appropriate.
  7. Designs and coordinates the billing processes and systems of the department; participates in the supervision and training of medical coding analysts, and oversees the resolution of billing and coding problems.
  8. Reviews and evaluates department interaction with external physicians, and designs and implements systems and procedures to improve communications and to provide feedback to referring physicians.
  9. Reviews the department's clinical contracts, and makes recommendations for improvements and enhancements as they impact department subspecialties.
  10. Develops and implements operating and compliance policies, procedures, and reporting systems; prepares and distributes periodic and ad hoc reports on practice and compliance issues and performance indicators.
  11. Performs miscellaneous job-related duties as assigned.

Minimum Job Requirements

  • High school diploma or GED; at least 9 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 analyze and interpret complex financial and operational data and prepare business reports, projections, and recommendations.
  • Working knowledge and strategic understanding of medical billing and reimbursement principles, procedures, and documentation.
  • Ability to communicate and interact effectively with practicing physicians and clinical management.
  • Skill in examining and re-engineering operations and procedures, formulating policy, and developing and implementing new strategies and procedures.
  • Knowledge of current legislation and developing legal issues and trends in medical billing, coding, and associated documentation.
  • Ability to make administrative and procedural decisions and judgments on sensitive, confidential issues.
  • Ability to supervise and train employees, to include organizing, prioritizing, and scheduling work assignments.
  • Advanced knowledge and understanding of the business and operating characteristics of a large, complex medical practice.
  • Ability to develop, prepare, and implement business plans and resource/revenue generating strategies.
  • Knowledge and understanding of the clinical contracting process for managed care, government, and private sector agencies.
  • Skill in the analysis and evaluation of clinical billing operations and provider productivity.
  • Knowledge of medical practice compliance.
  • Knowledge of health facility certification, licensing, accreditation, and provider credentialing as related to professional billing.

Distinguishing Characteristics

    Position requires: a) planning and monitoring of the clinical revenue-generating operations of a major, leading, multi-divisional clinical department; b) development and implementation of clinical operating benchmarks and standards; c) development of complex financial and operating analyses used directly in top management decision making; d) direct participation in business and operational planning and research for the clinical operations of the department; e) design and implementation of practice management systems and processes.

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: 06/27/2017