The University of New Mexico Health Sciences Center

Operations

• Performs a variety of routine day-to-day operations related to the administration of billing accounts for a defined University medical service or billing agent.
• Researches and prepares billings for initial electronic claims submissions.
• Verifies benefits eligibility and coverage for treatments, hospitalizations, and procedures.
• Enters information necessary for insurance claims such as patient, insurance ID, diagnosis and treatment codes and modifiers, and provider information.
• Insures claim information is complete and accurate.
• Prepares, reviews, and transmits claims using billing software, including electronic and paper claim processing.
• Identifies and bills secondary or tertiary insurances.
• Submits insurance claims to clearinghouse or individual insurance companies electronically or via paper CMS-1500 form.
• Ensures strict confidentiality of patient medical and financial records, in compliance with federal and state patient privacy legislation.
• Follows established departmental policies, procedures, and objectives.

Account Operations Tech 1

Medical Director

• Provide comprehensive medical care to patients
• Diagnose illnesses and develop treatment plans to promote optimal health
• Collaborate with other healthcare professionals to ensure high-quality patient care
• Contribute to the overall success of the medical facility
• Establishing, with healthcare facility staff and administration, the type and scope of services required to meet patient care requirements
• Directing the administration of all services throughout the designated UNMMG healthcare facility to include planning, directing, and supervising
• Developing and implementing policies and procedures which guide and support the provision of services in the designated healthcare facility
• Recommending the criteria for clinical privileges in the designated UNMMG healthcare facility
• Continuing surveillance of professional performance of all individuals with clinical privileges in the healthcare facility based on peer review procedures
• Maintaining quality control programs as appropriate
• Ensuring that all services are integrated into the UNMMG healthcare facility Performance Improvement Program
• Ensuring the orientation and continuing education of all persons in the designated UNMMG healthcare facility
• Making recommendations for space and other resources needed by the designated UNMMG healthcare facility
• Ongoing, effective operation of the designated UNMMG healthcare facility by assessing the improvement of its activities
• Collaboratively participates in the development of healthcare facility specific criteria for clinical privilege sets
• Completing annual evaluations and personnel actions as applicable in a timely manner
• Demonstrating fiscal responsibility, accountability and timeliness in the administration and operation of assigned UNMMG healthcare facilities

Medical Director – Dental Clinic

Manager

• Coordinates patient documentation to maintain eligibility for a variety of core medical and social support services;
• Conducts patient interviews required to complete intake applications and all required forms for core medical and social support services;
• Works closely with medical case managers to reduce patient barriers to obtaining needed medical care and /or social services;
• Assist with the identification of community resources that build support for medically and socially complex patients;
• Maintain current information on all regularly accessed community resources;
• Perform a range of administrative functions required to ensure efficient program operation.

Account Operations Tech 1

Medical Director – Dental Clinic

Non-Medical Case Manager