STATE OF NEW HAMPSHIRE
HUMAN RESOURCES
CLASSIFICATION: MEDICAL
SERVICE TECHNICIAN
Class Code: 6215-17
Date Established: 07-29-76
Occupational
Code: 7-7-7
Date of Last Revision: 12-28-01
BASIC PURPOSE: To review and
investigate medical data for use in determining state and federal compliance of
medical care service providers.
CHARACTERISTIC
DUTIES AND RESPONSIBILITIES:
·
Investigates
potential third party liability cases, referred and identified by many sources
to identify medical services appropriate for health insurance coverage, to
update information systems data on eligible claims, and to recover funds from
third party resources.
·
Researches medical
claims, data files, eligibility information, insurance coverage, and NH medical
assistance policies to determine liability for medical services payment, to
make payment or denial on medical claims, and to authorize third party billings
to insurance carriers.
·
Reviews and compares
data exchange material and computer generated data of recipient third party
information with the recipient medical history file in order to verify and
update third party information, and to recover funds expended when a third
party payor is responsible.
·
Modifies and
maintains recipient third party liability system files within our Medicaid
Management Information System in order to identify system program actions to
pay or deny claims properly.
·
Interprets and
explains State laws, department rules and department policy in contacts with
recipients, absent/custodial parents, district offices, medical providers,
employers, insurance carriers, attorneys and other professionals; provides
training and support to department staff.
·
Contacts providers
for eligibility request and cost ceilings to assist case managers in compiling
relevant data.
·
Reviews overall
impact of long term care services with case managers and medical professionals.
·
Visits clinics to
assess physical abilities, ADL skills, and other pertinent information from
which eligibility determinations are made.
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DISTINGUISHING
FACTORS:
Skill: Requires skill
in developing formats and procedures for special applications OR in
investigating and reviewing the use of equipment and data for a specialized
function.
Knowledge: Requires
knowledge of business practices and procedures or technical training in a craft
or trade, including working from detailed instructions, to apply knowledge in a
variety of practical situations.
Impact: Requires
responsibility for contributing to immediate, ongoing agency objectives by
facilitating the direct provision of services to the public or other state
agencies. Errors at this level
result in inaccurate reports or invalid test results and require significant
investment of time and resources to detect.
Supervision: Requires
direct supervision of other employees doing work which is related or similar to
the supervisor, including scheduling work, recommending leave, reviewing work
for accuracy, performance appraisal, or interviewing applicants for position
vacancies.
Working
Conditions: Requires performing regular job
functions in a controlled environment with minimal exposure to disagreeable job
elements and little risk of hazard to physical or mental health.
Physical
Demands: Requires light work, including
continuous walking or operating simple equipment for extended periods of time
as well as occasional strenuous activities such as reaching or bending.
Communication: Requires
summarizing data, preparing reports and making recommendations based on
findings which contribute to solving problems and achieving work
objectives. This level also
requires presenting information for use by administrative-level managers in
making decisions.
Complexity: Requires a
combination of job functions to establish facts, to draw daily operational
conclusions, or to solve practical problems. This level also requires providing a variety of alternative
solutions where only limited standardization exists.
Independent
Action: Requires a range of choice in applying
a number of technical or administrative policies under general direction and in
making routine decisions or in recommending modifications in work procedures
for approval by supervisor.
MINIMUM
QUALIFICATIONS:
Education: Associate’s
degree, or its equivalent, from a recognized college or technical school with a
major study in a health, medical or paramedical field, information systems, or
finance. Each additional
year of approved formal education may be substituted for one year of required
work experience.
Experience: Four years’
paraprofessional experience at the level of a case aide, case technician, or
related field. Each additional
year of approved work experience may be substituted for one year of required
formal education.
License/Certification: None required.
RECOMMENDED
WORK TRAITS: Paramedical knowledge of medicine and
surgical diagnosis and procedures.
Basic knowledge of scientific and therapeutic procedures provided by
various medical care providers.
Knowledge of the provisions of the Medicare and Medicaid programs. Ability to communicate
effectively. Ability to establish
and maintain harmonious working relationships with a variety of medical care
provider personnel as well as fellow employees. Must be willing to maintain appearance appropriate to
assigned duties and responsibilities as determined by the agency appointing
authority.
DISCLAIMER
STATEMENT: This class specification is descriptive
of general duties and is not intended to list every specific function of this
class title.
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