Official SealDepartment of Budget and Management


#26-001755-0005
Supplemental Questionnaire

Last Name
First Name

 

**Please note that your answers on the supplemental questionnaire must correspond to the information provided on your application to receive credit. Applications that do not include a completed supplemental questionnaire will be considered incomplete and may be subject to disapproval.**

 


1.

Describe your experience performing administrative staff, clerical, clerical technical, or secretarial work.

This experience should be included on your application, including hours and dates worked. If you do not possess this type of experience, please put N/A in the text box.

2.

Bilingual applicants are encouraged to apply.

Are you bilingual in English and Spanish? You must be fluent in English and Spanish, meaning that you must be able to fluently and effectively speak, write, and understand both English and Spanish.  

Yes No
3.

Describe in 1-3 paragraph(s), your experience working with electronic medical records.

Do not copy and paste from your resume. Please include name of employer, job title, dates of employment, and hours worked per week, this information must also be reflected in your application.   If you do not possess experience in this area, put N/A in the box below.

4.

Describe in 1-3 paragraph(s), your extensive experience and knowledge using Microsoft Word, Excel, PowerPoint and Outlook.

Do not copy and paste from your resume. Please include name of employer, job title, dates of employment, and hours worked per week, this information must also be reflected in your application.   If you do not possess experience in this area, put N/A in the box below.

5.

Describe in 1-3 paragraph(s), your experience with basic medical billing processes (eligibility verification, deductions, copays, prior authorizations, etc.)

Do not copy and paste from your resume. Please include name of employer, job title, dates of employment, and hours worked per week, this information must also be reflected in your application.   If you do not possess experience in this area, put N/A in the box below.

6.

Describe in 1-3 paragraph(s), your familiarity with community resources related to prenatal/postnatal care as well as other social services.

Do not copy and paste from your resume. Please include the name of employer, job title, dates of employment, and hours worked per week, this information must also be reflected in your application. If you do not possess experience in this area, put N/A in the box below.

7.

Describe in 1-3 paragraph(s), your experience with patient registration processes, including collecting and verifying demographic and insurance information.

Do not copy and paste from your resume. Please include the name of employer, job title, dates of employment, and hours worked per week, this information must also be reflected in your application. If you do not possess experience in this area, put N/A in the box below.

8.

Describe in 1-3 paragraph(s), your experience working effectively with diverse populations, including adolescents, young adults, and underserved communities.

Do not copy and paste from your resume. Please include the name of employer, job title, dates of employment, and hours worked per week, this information must also be reflected in your application. If you do not possess experience in this area, put N/A in the box below.


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