STATE OF NEW HAMPSHIRE
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.
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.
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.
Last Updated 05/10/02