STATE OF NEW HAMPSHIRE
HUMAN RESOURCES
CLASSIFICATION: PROVIDER SERVICES REPRESENTATIVE II
Class Code: 7142-22
Date Established: 02-20-80
Occupational Code: 7-7-7
Date of Last Revision: 12-28-01
BASIC PURPOSE: To coordinate liaison efforts between
Medicaid Management Information System (MMIS) fiscal agent and the Office of
Medical Services (OMS) to assure correct processing and payment of medical
claims.
CHARACTERISTIC DUTIES AND RESPONSIBILITIES:
·
Identifies and
resolves problems relating to complaints in the service delivery of health care
claims.
·
Identifies and
implements improvements in health care delivery systems to assist in reducing
service or provider-related problems.
·
Reviews federal and
state publications for changes and additions to regulations, and discusses
revisions with agency staff.
·
Resolves various
problems involving billing and/or data processing.
·
Trains support staff
and technical employees in business functions in the areas of claims, in
addition to the verification of financing or claims data generated by the
agency.
·
Assists superiors in
defining how federal and state policy changes will affect health care social
services provided.
·
Assists in developing
provider services policy and procedure manuals.
-------------------------------------------------------------------------------------------------------------------------------------------
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 logical or scientific
understanding to analyze problems of a specialized or professional nature in a
particular field.
Impact: Requires responsibility for achieving
direct service objectives by assessing agency service needs and making
preliminary recommendations for the development of alternative short-term
program policies or procedures.
Errors at this level result in incomplete assessments or misleading
recommendations causing a disruption of agency programs or policies.
Supervision: Requires direct supervision of other
employees doing related or similar work, including scheduling work,
recommending leave, reviewing work for accuracy, performance appraisal, or
interviewing applicants for position vacancies.
Working Conditions: Requires performing regular job
functions under good conditions in a safe working environment.
Physical Demands: Requires sedentary work, including
continuous sitting or occasional standing and walking.
Communication: Requires reviewing summaries and
reports and making management level decisions to solve problems or to achieve
work objectives as well as articulating and expressing those solutions and
goals. This level also requires
formal presentations of solutions and goals to employees and the general public
to increase the responsiveness of the agency toward the demands of its client
system.
Complexity: Requires coordinating a combination of
diverse job functions in order to integrate professional and technical agency
goals. This level also requires
considerable judgment to implement a sequence of operations or actions.
Independent Action: Requires objective assessment in
analyzing and developing new work methods and procedures subject to periodic
review and in making decisions according to established technical, professional
or administrative standards.
MINIMUM QUALIFICATIONS:
Education: Bachelor's degree from a recognized
college or university with major study in business or public administration,
public relations, social work, sociology, psychology, health care
administration, or human services.
Each additional year of approved formal education may be substituted for
one year of required work experience.
Experience: Four years' experience in public
contact work with medical or employment service providers or professional
organizations, two years of which must be involved in social or employment
service work at a technical or supervisory level.
License/Certification: None required.
SPECIAL REQUIREMENTS: For appointment consideration, Provider
Services Representative II applicants must successfully participate in a
structured interview measuring possession of knowledge, skills and abilities
identified as necessary for satisfactory job performance by this class
specification. The structured
interview is developed and administered, according to Division of Personnel
guidelines, by representatives of the state agency in which the vacancy exists.
RECOMMENDED WORK TRAITS: Knowledge of social services, billing
procedures, systems operations, and referral resources. Knowledge of business management
practices. Knowledge of report
writing. Knowledge of
statistics. Ability to speak to
professional people to clearly explain rules and state policy. Ability to analyze data and prepare
extensive technical and statistical reports. Ability to communicate effectively both orally and in
writing. Ability to establish and
maintain effective working relationships with medical community and the
public. 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.
Back to Human Resources Home Page
Back
to State Opportunities Listing Page
Back to Class Specification List
Last Updated 01/04/02
URL: /hr/classspec_p/7142.htm