STATE OF NEW HAMPSHIRE
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.
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.
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.
Last Updated 01/04/02