HomeMy WebLinkAboutCity Council - 6250 RESOLUTION NO. 6250
A RESOLUTION OF THE CITY COUNCIL OF THE
CITY OF HUNTINGTON BEACH TO ADOPT AND AMEND
THE CITY CLASSIFICATION PLAN
WHEREAS, the following amendment to the City' s
Classification Plan is recommended by the Personnel Commission
after a duly noticed and conducted public hearing as required
under Personnel Rule 12-4;
NOW, THEREFORE, be it resolved by the City Council of the
City of Huntington Beach as follows :
1. The Classification Plan shall be amended to include the
job description attached hereto as Exhibit "A" for the
classification of Medical Claims Processor.
PASSED AND ADOPTED by the City Council of the City of
Huntington Beach at a regular meeting thereof held on
the 4th day of March
Mayor
ATTES : APPROVED AS TO FORM:
City Clerk City Attor "ey �a� P%
REVIEWED AND APPROVED ATED A P
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City Administrator y A rinistra6r
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EXHIBIT A
CITY OF HUNTINGTON BEACH
CLASS SPECIFICATION
TITLE: MEDICAL CLAIMS PROCESSOR
DATE: JANUARY, 1991
DUTIES SUMMARY: Under general supervision, processes medical insurance claims for the
City's self insured, self-administered health plans and ensures proper payment, maintains
claims recordkeeping system and provides customer assistance to claimants and performs
related work as required.
EXAMPLES OF DUTIES: Reviews medical insurance claims, verifies benefits eligibility and
verifies that medical procedure performed is consistent with diagnosis; enters claim
information into computer, computes hospital claims discounts, maintains and updates
eligibility information for insured members; refers extraordinary and disputed claims to
third party medical reviewers and follows-up on pended claims; manually processes physical
therapy and chiropractic claims and calculates amount of payment for same; reviews claims
payment reports and exception reports and determines proper payment and handling, review
claims processed reports for possible errors and makes necessary corrections and issues
stop-payments and follows up on tracers; corresponds orally and in writing with doctors,
medical review board members and other healthcare providers to gather information
regarding medical procedures necessary to determine proper handling of claims; assists
claimants in claims filing procedures and interpreting their plan benefits in accordance with
the Plan Document and their collective bargaining agreement and explains reasons for
non-payment of claims; provides support and assistance to plan members on personal and
highly sensitive health care questions as related to benefits; acts as liaison between the
insured and third party reviewers of claims, hospitals, physicians and other health care
providers on claims issues and inquiries; oversees opening and matching mail, filing claim
documents, setting up new member folders, assembling materials for mailing and verifying
membership information. May perform related duties as required.
KNOWLEDGE, SKILLS, ABILITIES & PERSONAL ATTRIBUTES: Knowledge of medical
office procedures and practices; medical terminology, diagnoses and procedures; knowledge
of principles and practices of bookkeeping and insurance billing; ability to process medical
claims with speed and accuracy; ability to perform moderately complex arithmetic and
algebraic computations with accuracy; ability to read, understand and apply complex
policies, practices and procedures including the plan document, collective bargaining
agreements and medical procedures reference books; ability to maintain a complex claims
filing system; to keep detailed records of claims-in-process and paid or denied; to enter and
retrieve claims data using automated and manual claims recordkeeping systems; ability to
work independently; ability to work cooperatively with claimants, medical professionals and
staff; ability to provide moral support and assistance to plan members on personal, sensitive
and often emotional health care questions as related to health plan benefits; skill in
organizing work to process claims in a timely manner; skill in paying attention to detail.
MINIMUM QUALIFICATIONS: Sufficient training and/or experience to clearly demonstrate
the knowledge, skills, abilities and personal attributes required for this class as may be
demonstrated by high school graduation or G.E.D. equivalent and supplemented by
coursework in medical terminology, medical front office procedures, bookkeeping and two
years of responsible office clerical work with at least one year of experience processing
medical claims, preferably in health insurance claims office.
5596j
6250
Res. No. 6250
STATE OF CALIFORNIA
COUNTY OF ORANGE ss:
CITY OF HUNTINGTON BEACH )
I, CONNIE BROCKWAY, the duly elected, qualified City
Clerk of the City of Huntington Beach, and ex-officio Clerk of the
City Council of said City, do hereby certify that the whole number of
members of the City Council of the City of Huntington Beach is seven;
that the foregoing resolution was passed and adopted by the affirmative
vote of at least a majority of all the members of said City Council
at a regular meeting thereof held on the 4th day
of March 1991 by the following vote:
AYES: Councilmembers:
MacAllister. WZnchell, Silva, Green, Kelly, Robitaille
NOES: Councilmembers:
None
ABSENT: Councilmembers:
Moulton-Pa terse
(Aty Clerk and ex-officio Perk
of the City Council of the City
of Huntington Beach, California