GENERAL DEFINITION
--This is skilled clerical work providing interpretive and advisory services to the public or -employees. Work includes giving and eliciting information in situations that require the -employees to explain pertinent city and state regulations, ordinances, laws,and procedures. -Employees ascertain that received documents are properly and completely prepared, make -calculations to compute fees and other charges, initiate the processing of documents received, -contact various city agencies to resolve problems encountered. Employees in this class support -their service delivery responsibility by performing data entry and retrieval and records -maintenance through automated systems or through manual systems of records and files of -customer and employee information. Full time contact with employees or the general public to -provide and elicit information is especially significant. Work is performed under the supervision -of an administrative or clerical supervisor. -
- -TYPICAL EXAMPLES OF WORK (ILLUSTRATIVE ONLY)
-REQUIRED KNOWLEDGES, SKILLS AND ABILITIES
-
-KNOWLEDGE OF:
-
-SKILL IN:
-
-ABILITY TO:
-
MINIMUM ACCEPTABLE TRAINING AND EXPERIENCE
-(The following statement -represents the minimum training and experience standards which will be used to admit or reject -applicants for tests. Applications submitted by candidates for this class will be reviewed based -on training and experience requirements as approved on 12/89.)
-
-Both Specialties
-
Or any equivalent combination of education and experience determined to be acceptable by the Personnel Department. -
- -Additional Requirement for the Bilingual Specialty
-
-PHYSICAL AND MEDICAL REQUIREMENTS
-
-LICENSES, REGISTRATIONS, AND/OR CERTIFICATES
-
PAY RANGE: 8
-Class Established: 2/1966
-
-Latest Spec. Revision:
- CSC - 7/1994 ; Ad Board - 8/1994
-
-
-
-PMcG/sb/sb
-
1A37
+ +PAY RANGE: 8
+ +SERVICE +REPRESENTATIVE
+ +(Bilingual)
+ +(General)
+ +GENERAL DEFINITION
+ ++ +
This is skilled clerical work providing +interpretive and advisory services to the public or employees. Work includes +giving and eliciting information in situations that require the employees to +explain pertinent city and state regulations, ordinances, laws, and +procedures. Employees ascertain that received documents are properly and +completely prepared, make calculations to compute fees and other charges, +initiate the processing of documents received, contact various city agencies to +resolve problems encountered. Employees in this class support their service +delivery responsibility by performing data entry and retrieval and records +maintenance through automated systems or through manual systems of records and +files of customer and employee information. Full time contact with employees +or the general public to provide and elicit information is especially +significant. Work is performed under the supervision of an administrative or +clerical supervisor.
+ ++ +
TYPICAL EXAMPLES OF WORK +(ILLUSTRATIVE ONLY)
+ ++ +
BOTH SPECIALTIES
+ ++ +
Receives documents for recording of selected +data; checks documents for accuracy, completeness and conformity with state and +city regulations; rejects improperly prepared documents and explains proper +preparation; makes necessary calculations to compute costs and fees; collects +costs and fees; makes postings to accounts for fees collected; arranges for +collection of delinquent costs and fees.
+ +Interviews prospective health center patients; +obtains information on personal history, income, medical coverage, and +residency; determines eligibility for treatment; assists patients in completing +registration forms; explains fees and billing procedures to patients; initiates +processing of third party payments; reschedules appointments when necessary.
+ +Interviews new, promoted, demoted, +transferred, reinstated, and relief employees with a city department or agency; +informs employees of work locations, hours of work, salary, eligibility for +union membership and benefits; explains benefit options to employees; explains +extent of coverages; describes claim processing procedures; contacts +appropriate central agencies to resolve benefits and payroll problems; prepares +and processes appointment papers; initiates the processing of all employee +changes for benefits, such as changes in marital status, addition or deletion +of dependents, or changes in union membership.
+ +Receives departmental forms listing employee +changes for benefits; reviews changes for accuracy and appropriateness; +processes changes into employee records; forwards changes to payroll unit and +benefit providers; explains claims processing to employees and their +beneficiaries; contacts providers to resolve problems.
+ +Maintains automated or manual records and +files of employee, customer or account information.
+ ++ +
BILINGUAL SPECIALITY
+ ++ +
Performs duties described above in situations +where giving information to and interviewing persons in a non-English speaking +community is required; uses a designated non-English language to communicate +with them.
+ +Performs related work as required.
+ ++ +
REQUIRED KNOWLEDGES, SKILLS AND ABILITIES
+ ++ +
KNOWLEDGE OF:
+ ++ +
• the +English language and spelling
+ +• arithmetic
+ +· basic +computer applications and functions
+ +• office +practices and procedures
+ +• interviewing +techniques
+ ++ +
SKILL IN:
+ ++ +
• eliciting +information quickly and easily
+ +• giving +information clearly and concisely
+ +• making +varied arithmetic computations with speed and accuracy
+ ++ +
ABILITY TO:
+ ++ +
• learn +departmental functions and organization
+ +• learn +provisions of and interpretations of departmental, city and state regulations, +ordinances and laws as they apply to job assignment
+ +• make +judgement decisions where several courses of action are presented
+ +• understand +and speak the designated non-English language fluently for the Bilingual +specialty
+ +• use +a computer terminal keyboard to perform data entry and retrieval
+ ++ +
MINIMUM ACCEPTABLE TRAINING AND EXPERIENCE (The +following statement represents the minimum training and experience standards +which will be used to admit or reject applicants for tests. Applications +submitted by candidates for this class will be reviewed based on training and +experience requirements as approved on 12/23.)
+ ++ +
BOTH SPECIALTIES
+ ++ +
EDUCATION:
+ ++ +
Education equivalent to completion of the +twelfth school grade.
+ ++ +
AND
+ +EXPERIENCE:
+ ++ +
Two years of customer service experience.
+ ++ +
Any equivalent combination of education and +experience determined to be acceptable by the Office of Human Resources.
+ ++ +
ADDITIONAL REQUIREMENT FOR THE BILINGUAL SPECIALITY
+ ++ +
Sufficient training and/or experience to +converse effectively in the designated non-English language.
+ ++ +
PHYSICAL AND MEDICAL REQUIREMENTS
+ ++ +
Ability to physically perform the duties and +to work in the environmental conditions required of a position in this class.
+ ++ +
LICENSES, REGISTRATIONS AND/OR CERTIFICATES
+ ++ +
Possession of a valid proper class motor +vehicle operator's license as issued by the Commonwealth of Pennsylvania prior +to appointment and during tenure of employment as a Service Representative if +required by work assignment.
+ ++ +
CSC - 7/94
+ +Ad. Board - 8/94
+ +CSC - 11/23; Ad. Board - 12/23
+ ++ +
+ +
JH/TL
+ +GENERAL DEFINITION
+ ++This is specialized clerical work at an advanced level +in the Health Department’s Ambulatory Health Services division. Employees +in this class serve as a lead worker performing complex and complicated medical +clerical work either providing a variety of support services to medical staff +including nurses, dentists and physicians for the General specialty or posting +payments and reconciling billing errors for the Medical Coding specialty. Work +includes serving as receptionist and lead clerical support in a program area +such as adult medicine, pediatrics, family planning, pre-natal, dental, etc. +for the General specialty. Contacting physicians and other health agencies or +insurance companies to clarify and resolve discrepancies and keeping abreast of +changes are significant aspects of the work for the Medical Coding specialty. This +class is differentiated from the lower level class by an increased emphasis on composing +and generating report data of patient statistics and addressing patient +concerns with departmental processes and systems. Employees in this class +are supervised by administrative or technical supervisors.
+ +ALLOCATING FACTORS: (The +following conditions must be met for a position to be allocated to this class.)
+ +· +Employees +in this class must perform advanced medical clerical work in the +Health Department’s Ambulatory Heath Services.
+ +TYPICAL EXAMPLES OF WORK +(ILLUSTRATIVE ONLY)
+ +ALL SPECIALTIES
+ +Navigates the eligibility and referral process for +insurance and entitlement information; ensures compliance with the Health +Insurance Portability and Accountability Act (HIPAA) and other confidentiality +laws in order to protect patient privacy when handling records in a crowded +work environment; obtains patient signatures on HIPAA, Consent to Treat and +Authorization, Authorization forms, etc. and informs patients of their rights +under HIPAA; determines whether requested medical information is protected or +whether it can be released to family members, legal guardians, health care +providers, lawyers and insurance companies and obtains medical records or other +information from outside health facilities; audits medical records for +proper documentation, completeness and accuracy; retrieves records from storage +to fulfil record’s requests; handles subpoena processing ensuring the timely +and accurate retrieval and submission of medical records; deactivates medical +records in the record storage system in accordance with the retention +schedule.
+ +Prepares +queries to physicians and other medical sources to obtain clarification of +information received; reviews information received for accuracy and correctness.
+ +Posts +electronic remits and payments; manages claim appeals; uploads Community +Behavioral Health (CBH) claims for payment; scans documents and reports into +Imaging/Records Management system and performs relating scanning functions.
+ +Submits +authorization for services with insurance companies for services, closes the +loop upon approval and denial, and informs the patient of their financial +responsibilities for services.
+ +Prepares +and submits daily, weekly, bi-weekly, monthly, and annual reports on patient +statistics, appointment schedules, and the related; performs quality control +verification for departmental processes and systems; promotes continuous +communication between administrative and direct patient care services teams; responds +to inquiries regarding department complaints, deficiencies, and documentation +requirements; participates in the Health department’s performance improvement +activities.
+ +Utilizes +various software packages, such as Univerge, Elclinicalworks, Transunion, +Navinet, Promise, Connex, United Healthcare, UPMC, Pear, Emdeon, Availtity, +HealthTrio, Versatile, and Philavax, to provide timely and high-quality +administrative support; assists in the care and maintenance of department +equipment and reporting systems and reports problems to the Help Desk or +appropriate departmental staff.
+ +Performs +related work as required.
+ +BILINGUAL SPECIALTY
+ +Performs the duties described above with members of the +English language speaking and designated non‑English language speaking +populations.
+ +GENERAL SPECIALTY
+ ++ +
Performs clerical duties relating to patient care; +determines patients’ eligibility for care; confirms patient identification and +ensures patients meet the residency requirement; assesses patients’ financial +liability for services; obtains demographic and insurance information needed to +complete registration process; researches insurance eligibility coverage using Electronic +Verification System (EVS) or via Internet; using Navinet and Promise, +Meddata, and Pear; promptly and accurately enters insurance information +into the billing system to ensure reimbursement; refers uninsured patients to +benefits counselors; maintains records on specialty care referrals on +uninsured patients; confirms receipt of report from referring physician so that +payment to hospital specialists can be processed.
+ ++ +
Plans and assigns work to lower-level clerical employees, +volunteers, and interns; checks work upon completion for accuracy and +completeness; trains new employees in work routines, departmental procedures, +and policies.
+ ++ +
Acts as a receptionist to greet patients; answers routine +inquiries, monitors patient flow and oversees the reception area; answers +telephone calls taking messages or transferring the call as appropriate; +schedules appointments, contacts other agencies to arrange for +transportation for patients (paratransit) and other routine matters; accesses +language line and/or in-person interpreters; handles a high volume of +patients and uses judgment when enforcing guidelines such as eligibility; directs +patients to the appropriate medical program such as OB/GYN, Pre-Natal +Adult Medicine, or Dental based on patient care needs; explains +health center procedures and regulations to patients, families and health +center visitors.
+ ++ +
MEDICAL CODING SPECIALTY
+ ++ +
Operates +interactive personal computer; enters demographic and other medical +information; extracts data from data base using non-procedural program language +to compose statistical reports; devises format for reports; reviews quality of +reports, correcting errors as needed before distributing; prepares weekly and +monthly statistical reports for state and federal authorities; maintains a +computer-generated mailing list to distribute statistical reports.
+ +Contacts +providers, health centers, medical examiner, patients and various other sources +to obtain information required to resolve discrepancies.
+ +Generates +reports to correct coding errors.
+ +Posts +payments received from health insurance providers for medical services provided +by City health centers; utilizes electronic remittance to post Medicare, +Medicaid, Blue Shield and other third-party commercial carrier payments; +reviews Medicare and other insurance benefits reports to reconcile billing +errors; identifies claims that were rejected due to billing or information +errors; reviews denial codes to determine the specific reason claims were +rejected.
+ +Generates +reports on rejected claims and procedure code errors; analyzes and corrects the +financial error report; performs mathematical computations to determine +percentages paid by health insurance providers.
+ +Generates +invoices for health care accounts receivable function; performs billing, +posting and reconciliation activities.
+ ++ +
REQUIRED KNOWLEDGE, +SKILLS AND ABILITIES
+ ++ +
KNOWLEDGE OF:
+ ++ +
ALL SPECIALTIES
+ +· medical +terminology
+ +· medical +office billing processes
+ +· basic +arithmetic
+ +· spelling +and language skills
+ ++ +
GENERAL SPECIALTY
+ ++ +
· principles +and practices of medical office management and supervision
+ +· the +medical facility’s organization and services
+ +· the +types and purpose of medical coding for procedures and diagnoses
+ +· health +care insurance carriers including managed care, Medicare, fee of service, and +indemnity programs
+ +· the +basic rules and regulations governing patient care
+ +· medical +records associated with the program (dental, adult medicine, pediatrics, family +planning, pre-natal, etc.)
+ +· applicable +legal and administrative requirements pertaining to the release of information
+ +· the +Health Insurance Portability and Accountability Act (HIPAA) and other +confidentiality laws in order to protect patient privacy
+ +MEDICAL CODING SPECIALTY
+ +· medical +coding procedures using ICD-10 manuals (International Classification of +Diseases-10)
+ +· the +objectives and procedures used in medical record-keeping systems
+ +· interactive +personal computer data entry and retrieval procedures
+ +· basic +bookkeeping principles and practices
+ +· standard +accounting and/or billing procedures of the City
+ +SKILL IN:
+ +ALL SPECIALTIES
+ +· the use +of Electronic Medical Records (EMR) in report generation and records +maintenance
+ ++ +
GENERAL SPECIALTY
+ ++ +
· the +operation of office machines, including automated systems, required by work +assignments
+ +· medical +billing software packages such as eClincialWorks (eCW) and insurance +verification tools such as Navinet and Promise
+ +· the +numeric and alpha filing of patient records
+ ++ +
MEDICAL CODING SPECIALTY
+ +· + the proofing and verification of machine and +computer-produced statements
+ ++ +
ABILITY TO:
+ ++ +
ALL SPECIALTIES
+ +· work +independently on difficult or complex clerical tasks
+ +· make +varied arithmetic calculations
+ +· express +ideas effectively both orally and in writing
+ ++ +
GENERAL SPECIALTY
+ +· plan, +assign and review the work of lower-level clerical employees, volunteers, and +interns
+ +· maintain +complex clerical records and prepare a variety of reports
+ +· make +judgment decisions where several alternative courses of action are presented
+ +· establish +and maintain effective working relationships with associates, other City +agencies, and the general public
+ ++ +
MEDICAL CODING SPECIALTY
+ +· learn +diagnosis and procedure codes associated with medical billing
+ +· learn +one or more non-procedural program languages
+ +· prepare +statistical reports
+ +· maintain +favorable working relationships with representatives of outside agencies, +professional and medical personnel, health insurance providers, and other +employees
+ +· read, +understand and interpret health care and health insurance data
+ +· learn +the various regulations related to work assignment
+ ++ +
MINIMUM ACCEPTABLE +TRAINING AND EXPERIENCE (The following statement represents the minimum +training and experience standards which will be used to admit or reject +applicants for tests. Applications submitted by candidates for this class will +be reviewed based on training and experience requirements as approved on 12/23.) +
+ ++ +
ALL SPECIALTIES
+ +EDUCATION:
+ ++ +
Education +equivalent to completion of the twelfth school grade.
+ ++ +
GENERAL +SPECIALTY
+ ++ +
AND
+ +SPECIFIC EXPERIENCE:
+ +One year as a +Medical Clerk in the Health Department performing clerical procedures in the Ambulatory +Health Services Division.
+ ++ +
MEDICAL CODING +SPECIALTY
+ ++ +
AND
+ ++ +
SPECIFIC EXPERIENCE:
+ ++ +
One +year as a Medical Clerk in the Health Department performing work in a +centralized billing and reimbursement unit, using the appropriate health +information software.
+ ++ +
ADDITIONAL REQUIREMENT FOR THE +BILINGUAL SPECIALTY
+ ++ +
+Sufficient +training and/or experience to be able to understand and speak fluently and +clearly in English and the designated non‑English language.
+ ++ +
PHYSICAL AND MEDICAL +REQUIREMENTS
+ ++ +
Ability to physically perform +the duties and to work in the environmental conditions required of a position +in this class.
+ ++ +
+ +
Class +Established:
+ +CSC -11/23
+ +Ad. Board - 12/23
+ +CP
+ ++ +