Medical administration job description

This post includes 3 parts: duties list, job qualification and job description writing tips for Medical administration in details. A complete job description concludes Medical administration key duties/responsibilities, Medical administration job qualifications (knowledge, education, skills, abilities, experience…KSA model) and other ones such as daily tasks, key activities, key/core competencies, job functions/purpose…

I. List of Medical administration duties:

1.     Oversee Utilization Management and Reimbursement departments within the organization. Specifically focus on ensuring the company is adhering to regulatory and client requirements as it pertains to benefit payment, case management and disease management.

2.     Collaborate with Chief Operating Officer on different strategic initiatives to better align the departments for meeting organizational goals and objectives.

3.     Utilize statistical techniques to analyze various sources of data to develop and maintain key performance metrics, evaluate trends, and to manage staff to appropriate metrics to drive behaviors.

4.     Apply concepts and tools of the medical/managed care industry to fully understand and manage benefit cost structure across client markets.

5.     Identify, develop and implement best practices to ensure improved efficiency, cost effectiveness, and contractual requirements are met and/or exceeded.

6.     Foster an environment of continuous improvement though process and systematic efficiencies.

7.     Work in conjunction with Human Resources to evaluate viable candidates under consideration for hire by identifying necessary skills and core competencies for various roles, developing relevant interview questions to assess candidate knowledge, skill, and position fit with future growth and business objectives, and utilizing appropriate selection techniques.

8.     Develop, and motivate staff.  Initiate and communicate a variety of personnel actions including employment, termination, performance reviews, salary reviews, disciplinary actions, and development plans.  Provide regular and behaviorally specific feedback to increase performance levels.

9.     Interpret and communicate accurate benefit information to staff by having a comprehensive understanding of benefits for multiple markets.

10.  Act as primary contact for Reimbursement and Utilization Management during new customer on-boarding and provide direction to staff to ensure understanding and ability to service new clients accurately.

11.  Develop and maintain client relationships by interacting directly with clients on escalated issues and providing feedback and communication as appropriate.

12.  Ensure departments are meeting appropriate quality standards through audits, appropriate controls, and review of practices and outcomes. 

13.  Ensure staff is providing accurate and timely service to Members and Providers that contact them directly with questions and direct others to appropriate areas in the organization when unable to assist.

14.  Work closely with management team to develop and implement appropriate training methods to ensure staff is provided with the appropriate tools to meet client requirements and objectives.

15.  Work effectively and collaboratively with peers and other internal resources in diagnosing and resolving issues.

16.  Regularly work with management staff to evaluate policies and procedures and facilitate the development and implementation of new efficiencies based on assessments.

17.  Update Chief Operations Officer on any significant issues in relation to clients and providers.

18.  Acts as expert in the areas of Utilization Management and Reimbursement and aid in answering Request for Proposal (RFP) questions regarding any of these areas.

19.  Foster an environment that focuses on ensuring integrity, respect, accountability, and superior service.

II. List of Medical administration qualifications

1.     Bachelor’s degree in Business, Health Care or other related field is required.

2.     5 - 7 years of experience in a managed care environment.

3.     5 - 7 years of management experience.

4.     Extensive knowledge of the Medicare and/or Medicaid program, particularly the coverage and payment rules.

5.     Knowledge of medical procedures, terminology, and coding.

6.     Excellent oral and written communication skills.

7.     Ability to manage multiple priorities and remain organized with multiple interruptions.

8.     Demonstrated ability to improve processes by creating efficiencies and/or saving money.

9.     Ability to successfully lead teams.

10.  Demonstrated skill in utilizing data to drive decisions and behaviors.

11.  Demonstrated use of Microsoft Office products (Word, Excel, Powerpoint).

III. Tips to write job description

1. Too-long job description:

Looking at a too-long job description can frighten the candidates off and drive the away. A job description, no matter how important the job is, should not be included in more than 3 pages. If one focuses on too many things at a time, he shall definitely lose focus on the main items and get overwhelmed by the remaining; So, keep it concisely.

2. Too-short job description:

While too-long can be a problem, too-short is more a problem. It will ruin the meaning of the job description. A too-short one means it lacks necessary details and therefore, the candidate will not be able to understand while reading it.

3. Listing unnecessary functions or job duties:

Just classifying these into the “others” category will save you a lot of effort and space. On the other hand, the job description will become more dilute and easy to be neglected.

4. Key functions

Not listing key functions as required for the job can be a fatal mistake to a job description.

5. Grammar and spelling

Poor grammar and having spelling errors can ruin the job description, too. Never think that as you are the employer, you may have the right to make grammar or spelling errors while requires other not to. A job description with such errors is easily to be mistaken as a fake or ghost ads; as a result, the candidate will turn away from it.

6. Not specific enough:

Be specific and concise; if you don’t address the specific, then what the job description is for. It is for the candidate to understand just exactly what he needs to do or needs to have. Lacking details can confuse the candidates very well.

7. Not having the job description reviewed by others:

This is also a common mistake. One may be subject to bias, but more than one, especially with the help of those external advisor, the job description can be more perfect.

8. Using buzzwords or abbreviations:

In fact, it is not necessary at all to use such in a job description.

9. Using slang or legal words:

Just use common wording to communicate with others and don’t do anything extraordinarily.

10. Not updating the job description:

The same job may require different duties and responsibilities in different times, so, you cannot use the same job description for 2 different times.