POMONA VALLEY HOSPITAL MEDICAL CENTER

National Labor Relations Board - Unpublished Board Decisions

Jan 11, 2019

21-RC-166499 (N.L.R.B. Jan. 11, 2019)

1
UNITED STATES OF AMERICA
BEFORE THE NATIONAL LABOR RELATIONS BOARD
POMONA VALLEY HOSPITAL MEDICAL
CENTER
Employer
and Case 21-RC-166499
SERVICE EMPLOYEES INTERNATIONAL
UNION, UNITED HEALTHCARE WORKERS-WEST
Petitioner
DECISION ON REVIEW AND ORDER
Pursuant to a Decision and Direction of Election, an election was conducted on January 21
and 22, 2016,1 in a unit of all full-time and regular part-time nonprofessional and technical
employees employed by the Employer at its acute care hospital facility in Pomona, California.
The Tally of Ballots shows 531 for and 458 against the Petitioner, with 218 determinative
challenged ballots. No objections were filed.
On June 9, following a hearing, the hearing officer issued a report in which he recommended
sustaining the challenges to 153 of the ballots and overruling the challenges to 65 of the ballots.
The Employer filed exceptions with respect to the challenges the hearing officer recommended
sustaining. On March 17, 2017, the Regional Director issued a Supplemental Decision and
Direction to Sustain Certain Challenged Ballots and Count the Remaining Challenged Ballots.
The Regional Director agreed with the hearing officer that 136 challenges should be sustained,
finding that 135 of these voters were business office clericals (BOCs) excluded from the unit and
that one challenge should be sustained on other grounds. Contrary to the hearing officer, the
Regional Director overruled 17 challenges, finding these voters were not BOCs and thus were
properly included in the unit.
Thereafter, in accordance with Section 102.67 of the Board’s Rules and Regulations, the
Employer and the Petitioner each filed a timely request for review. The Employer argued that
the Regional Director improperly sustained 1312 out of the 136 sustained challenged ballots, and
that those ballots should be overruled. The Petitioner contended that the Regional Director erred
by overruling the challenges to the 17 ballots. The Employer filed an opposition to the
Petitioner’s request.

1 All dates are 2016 unless otherwise indicated.
2 The Employer stated that it requested review of 132 of these ballots, but the Request for
Review only discussed 131.
2
On December 15, 2017, the Board3 granted review of the Employer’s Request for Review
solely with respect to the Regional Director’s exclusion of the Information Technology (IT)
Clericals, Telecommunications Technician, Worker’s Compensation Claims Specialist,
Education Coordinator, Charge Revenue Representatives, System Coordinator Laboratory, and
Nursing Staff Coordinators from the unit. The Board also granted the Petitioner’s Request for
Review solely with respect to the Regional Director’s inclusion of the Specialist HIM Data
Integrity, Application Specialist, and Application Specialist, Perioperative.4 The Requests for
Review were denied in all other respects. Thereafter, the Petitioner and the Employer filed briefs
on review.
The National Labor Relations Board has delegated its authority in this proceeding to a three-
member panel.
Having carefully considered the entire record in this proceeding, including the briefs on
review, for the reasons stated below, we affirm and reverse the Regional Director’s disposition of
the challenges in the following respects.
First, for the reasons he stated, we affirm the Regional Director’s exclusion of the following
IT Clericals as BOCs: Executive Secretary, Information Systems; Enterprise Practice
Management (EPM)-Electronic Medical Record Information System (EMRIS) Specialist5;
System Analysts I, II, III; Software Engineers III; Applications Specialist Materials Manager;
Healthcare Intelligence Architect; Clinical Support Liaisons, Information Services; System
Engineers I, II, III; Helpdesk Technicians; Desktop Engineers; Network Engineers; Enterprise
Practice Management (EPM) Specialist; and Senior Security Administrator.6

3 Former Chairman Miscimarra and Member Kaplan; former Member Pearce dissenting in part.
4 In total, the grant of review covers the ballots of 69 employees (64 subject to the Employer’s
request for review, 5 subject to the Petitioner’s).
5 Contrary to the Employer’s contentions, we find that the excluded EPM-EMRIS Specialist
classification is distinguishable from the Nursing Service Systems Analyst position, which we
find should be included in the unit for the reasons discussed below. Unlike the Analysts, who
work in the main Hospital, the Specialist works in the separate Chaney Seinfeld building with
other IT employees and is supervised under that department. Further, unlike the Analysts, she
works primarily with the Hospital clinics located off-site from the main campus, where she
manages, monitors, and evaluates the EPM-EMRIS, and works with the senior systems analysts
and vendors to plan and implement the EPM-EMRIS. Although the Analysts and the Specialist
both troubleshoot computer systems, they are responsible for different systems and the
Specialist, unlike the Analysts, is also responsible for the health information exchange. Finally,
there is no specific evidence to show that the Specialist has substantial contact with unit
employees.
6 In affirming the Regional Director’s exclusion of these IT Clericals, we note that the Board has
typically considered IT positions to be BOCs, and the Regional Director’s decision with respect
to these classifications is consistent with precedent in this area. See e.g., Rhode Island Hospital,
313 NLRB 343, 360-361 (1993); Trumbull Memorial Hospital, 218 NLRB 796, 797 (1975). We
do not rely on the Regional Director’s citation to Silver Cross Hospital, 350 NLRB 114 (2007),
3
Second, we affirm the Regional Director’s exclusion of the Infrastructure Technician, another
IT Clerical, but on the basis that the Infrastructure Technician is a skilled maintenance
employee.7
Third, we affirm the Regional Director’s exclusion of the Workers Compensation Claims
Specialist,8 Education Coordinator,9 and Telecommunications Technician.10

as that case presented the issue of whether computer operators at an acute care facility should be
included in a skilled maintenance unit, and did not address whether they are BOCs.
Member Kaplan agrees with his colleagues that, under existing precedent, the Regional
Director properly excluded the IT Clericals set forth above as BOCs. However, in light of the
changes in computer systems over the past forty years, it is his view that the Board should revisit
its sparse and dated precedent concerning whether IT Clericals should be excluded on this basis.
Member Kaplan believes that many of the IT Clericals set forth above should instead be
excluded as skilled maintenance employees. But he does not believe this is the appropriate case
to revisit the precedent on this issue because the Employer did not argue that the IT Clericals
should be included in the skilled maintenance unit.
Skilled maintenance employees “perform functions apart from those of unskilled service,
maintenance, and clerical employees in that these employees deal with highly complex and
sophisticated systems and equipment. . . . While they occasionally perform routine unskilled
tasks, skilled maintenance employees are generally engaged in the operation, maintenance, and
repair of the hospital’s physical plant systems, such as heating, ventilation, air conditioning,
refrigeration, electrical, plumbing, and mechanical. . . . Work on these systems requires abstract
skills and knowledge at levels considerably higher than those of other nonprofessional hospital
employees.” St. Luke’s Health Care Assn., 312 NLRB 139, 140 (1993) (quoting Collective-
Bargaining Units in the Health Care Industry, 53 FR at 33920). In Member Kaplan’s view,
many of the IT Clericals set forth above belong in a skilled-maintenance unit because they use
more “abstract skills and knowledge” on “highly complex and sophisticated systems and
equipment.” He further observes that the hospitals’ IT infrastructure is part of the modern
physical plant together with the traditional heating, ventilation, air conditioning, refrigeration,
electrical, plumbing, and mechanical.
Chairman Ring agrees that existing precedent regarding the placement of IT Clericals
warrants review in a future appropriate case in light of changes in the nature of IT functions over
the past forty years. At this time, he expresses no view as to the potential unit into which such
employees would appropriately be placed.
7 The Regional Director included Infrastructure Technician Augustus Prieto’s name in the list of
challenges that were sustained, but inadvertently omitted any analysis of this classification or
individual. In affirming the Regional Director’s exclusion of Prieto, we emphasize, as noted by
the hearing officer, that Prieto’s functions—troubleshooting computer systems and installing
hardware, network, and telephone cabling—are more typical of a skilled maintenance employee.
See e.g., Presbyterian University Hospital d/b/a University of Pittsburgh Medical Center, 313
NLRB 1341, 1341, 1343, 1345-1347 (1994) (telecommunications specialists responsible for
installing and repairing the employer’s telephone network found to be skilled maintenance
employees); Toledo Hospital, 312 NLRB 652, 653-654 (1993).
4
Fourth, we affirm the Regional Director’s inclusion of the Applications Specialist11 and
Application Specialist, Perioperative.12
Finally, for the reasons explained below, we reverse the Regional Director’s findings in
several respects. Specifically, we find that the following classifications should be included in the
unit: Nursing Service Systems Analysts (an IT Clerical classification), Charge Revenue
Representatives, System Coordinator Laboratory, and Nursing Staff Coordinators. We also find
that the Specialists HIM Data Integrity should be excluded from the unit.

8 In affirming the Regional Director’s exclusion of the Workers’ Compensation Claims Specialist
from the unit, we find, contrary to the Employer, that the Specialist is part of Human Resources
(HR), as she performs HR functions, the Occupational Health Services and Workers’ Comp
section and her position are listed under HR in the Employer’s organizational chart, and her
supervisor reports to the vice-president of HR.
9 In affirming the Regional Director, we emphasize that 1) the Education Coordinator’s
responsibilities are specific to assisting Hospital employees and external patrons with continuing
education and training, and her tasks are not directly related to patient care services; 2) she is part
of the education department and functions in the HR realm; 3) although she is located in the
main Hospital, she has her own office which is not in a patient care area, and she does not have
patient interaction; 4) her supervisor does not supervise any unit employees; and 5) there is no
evidence or contention that she works in a department with unit employees and her contact with
unit employees is limited to assisting them with continuing education and training.
10 As the Board has typically found that such employees perform skilled maintenance functions,
we affirm the Regional Director’s exclusion of the Telecommunications Technician on the basis
that he is a skilled maintenance employee. In doing so, we note his involvement in the extensive
repair and installation of hospital communications equipment and that he works with
Infrastructure Technician Prieto pulling cable. See Presbyterian University Hospital d/b/a
University of Pittsburgh Medical Center, supra.
11 In affirming the Regional Director’s inclusion of the Application Specialist, we emphasize that
he 1) works in the pharmacy department (a patient care-related department); 2) reports to the
Director of Pharmacy, who also supervises the pharmacy technicians (undisputed unit
employees); 3) was trained as a pharmacy technician (although he does not work in that
capacity); and 4) has contact with unit employees when training pharmacy technicians on the
computerized pharmacy and clinical information systems and performing troubleshooting.
Finally, the Board traditionally considers pharmacy department clericals to be hospital clericals.
Medical Arts Hospital of Houston, 221 NLRB 1017, 1018-1019 (1975).
12 In affirming the Regional Director, we emphasize that the Application Specialist, Perioperative
1) works in the main Hospital in the operating room suite and near the surgical suites; 2) reports
to the Director of Perioperative Services, who also supervises unit employees; and 3) has contact
with unit employees when she trains them on the surgery information systems and assists them
with access issues. See Newington Children’s Hospital, 217 NLRB 793, 795 (1975) (“hospital
clericals…are located geographically throughout the hospital, within various departments
composed of other service and maintenance employees” and “[t]heir work and working
conditions are materially related to unit work”).
5
Nursing Service Systems Analysts: The Regional Director, in agreement with the hearing
officer, excluded Nursing Service Systems Analysts Araceli Arriaga and Judy Carrillo from the
unit along with all of the other IT Clericals, as the Board generally views nontechnical IT work
as BOC work. Rhode Island Hospital, supra at 360-361; Trumbull Memorial Hospital, supra at
797.13 Contrary to the Regional Director, and in agreement with the Employer, we include the
Analysts in the unit. The Analysts are not part of the IT department, they work in the main
Hospital (Analyst Arriaga works adjacent to the nursing staff office and Analyst Carrillo
adjacent to Hospital rooms, in an area known as “Surgery”), and they report to supervisors who
supervise other unit employees.14 Further, the Analysts have contact with unit employees
(LVNs, CNAs, and patient care associates) in the course of their duties troubleshooting issues
regarding information systems in each of their areas. Finally, Carrillo wears scrubs all of the
time for convenience due to time spent in the surgery area.
Charge Revenue Representatives: The Charge Revenue Representatives reconcile the data
that doctors or nurses complete regarding a patient (both electronic and written), and chart that
information into a single report, so that information can be used as a basis for charging the
patients. They do not generate bills, but generate charges that ultimately carry over to patient
billing. The Representatives perform data entry and communicate with billers in the business
office daily (through phone, email, and reports) to ensure that all of the data for billing is
received, and need a minimum of two years of billing experience to work in the position.15
The Regional Director, in agreement with the hearing officer, excluded the Charge Revenue
Representatives from the unit as BOCs because their work directly affects billing, a BOC
function, and they do not work alongside unit employees the majority of the time.16 He also
relied on the fact that they are currently not located in the emergency room (ER), and it is
unclear where they will be permanently located.

13 According to the job description, the Analysts must have a working knowledge of the nursing
staff office or surgical services scheduling systems, and are responsible for 1) all system
functionality, reporting and support; 2) the prevention, detection, diagnosis and resolution of
computer-related issues for the nursing office or surgical services operating systems; 3) the
creation and maintenance of databases; 4) developing reports; and 5) instructing end users in
these systems as needed.
14 Analyst Arriaga reports to Lola Mitchell, the Director of Nursing Operations and Clinical
Practices, and Analyst Carrillo reports to Martha Soto, the Director of Clerical Services.
Mitchell and Soto also supervise LVNs, CNAs, patient care associates, and other unit employees.
15 As set forth in the job description, the Charge Revenue Representatives are responsible for 1)
processing observation unit or emergency room held report on a daily basis; 2) posting charges
to the financial system and reconciling revenue reports and patient accounts; 3) maintaining
communication with the business office on a daily basis; 4) ordering office supplies and
equipment on-line and distributing this to staff; and 5) knowing medical billing codes in order to
ensure proper billing.
16 The Regional Director grouped all of the coder classifications together in his discussion, and
found that while they occasionally work in the hospital for training and other duties, they mostly
work from home. However, there is no evidence that the Charge Revenue Representatives work
from home.
6
Contrary to the Regional Director, we find that the Representatives are more akin to hospital
clericals than BOCs and accordingly include them in the unit. Significantly, the Representatives
report to the Director of the ER, who also supervises unit employees, such as nurses and ER
techs. Further, the Representatives are clearly an integral part of the ER department, which is
intimately involved in patient care. Under normal conditions they have worked in the ER and
were only temporarily moved to a medical office building across the street due to a construction
project in the ER. However, they will eventually relocate back to the main Hospital after the
construction in the ER is complete. The Representatives interact with unit employees in the ER
in the normal course of performing their functions. Finally, they do no actual billing or coding.

System Coordinator, Laboratory: The Coordinator assures that charges for lab tests
generated in the laboratory are done properly so that when they go to patient billing the charges
are accurate. Thus, she ensures the proper functioning of the billing processes and performs data
entry. She also performs departmental payroll and attendance documentation functions for the
entire laboratory.17 The Regional Director, in agreement with the hearing officer, excluded the
System Coordinator, Laboratory from the unit as a BOC, since most of her work involves billing
and personnel, typically BOC functions. Contrary to the Regional Director, we find that the
Coordinator is more akin to a hospital clerical than a BOC, and accordingly include her in the
unit. The Coordinator works in the main Hospital in a cubicle in the laboratory across from the
Laboratory Director’s office, and reports to the Laboratory Director and not to the business or
personnel office. She performs clerical functions such as taking minutes at staff meetings, in
addition to her billing-related functions. In the laboratory, she is surrounded by unit employees,
and has daily interactions with them (particularly the phlebotomists and laboratory customer
service liaisons) as part of performing payroll and attendance functions or when she takes
minutes at staff meetings. Finally, there is no evidence that she has regular contact with the
business office.
Nursing Staff Coordinators: The main role of the Nursing Staff Coordinators is to ensure that
each unit is appropriately staffed on a daily basis. The Coordinators specifically ensure the
staffing of RNs, LVNs, nursing assistants, patient care support technicians, and ward clerks. The
staffing numbers are generated by a system dependent on the number of patients in any given
unit. If a unit needs more staffing, the Coordinators will call employees and ask if they can
work, or they may tell employees that they are not needed. In doing so, they interact with all of
those classifications. The Coordinators work with HR as they record employees’ shifts and time
off through data entry.18

17 According to her job description, the Coordinator performs primary billing functions for the
laboratory, ensures proper function of the billing processes, provides general oversight of billing
functions in the absence of the Laboratory Information System manager, monitors daily
computer function and performs required maintenance, performs maintenance of the physician
and CDM tables in the laboratory information system, and performs departmental payroll and
attendance documentation functions for the entire laboratory.
18 The Nursing Staff Coordinators’ job description summarizes their major function as follows:
“Under the direction of the resource supervisor, performs a specific set of duties culminating in
the appropriate and timely staffing, patient acuity, productivity, and payroll needs of the Nursing
7
The Regional Director, in agreement with the hearing officer, excluded Nursing Staff
Coordinators from the unit as BOCs because they basically perform a personnel/HR function,
relying on St. Luke’s Episcopal Hospital, 222 NLRB 674, 676 (1976) (excluding the personnel
department as BOCs).
In reversing the Regional Director, we emphasize that the Coordinators work in the main
Hospital away from the business and personnel offices. Although they work in collaboration
with HR/payroll, i.e., they record employees’ shifts and time off, it appears that this work is done
through data entry, and there is no evidence of additional contact with HR. Further, the function
of the Coordinators of ensuring proper nursing staff ratios is not specifically an HR function and
this function is instrumental to patient care. In addition, the Coordinators do not specifically
work as part of the HR department, but rather come under the general umbrella of nursing
operations. Thus, they work under the direct supervision of the Director of Nursing Operations
and Clinical Practice,19 who also directly supervises unit employees in the “float pool,”
(including LVNs, RNs, nursing assistants, and ward clerks that do not have a permanent
assignment). Finally, the Coordinators clearly have contact with unit employees when they call
them in or tell them that they are not needed.
St. Luke’s Episcopal Hospital, supra, relied on by the Regional Director, is distinguishable
from the instant case. In that case, unlike here, the disputed employees found to be BOCs
worked in the personnel department, while the Coordinators at issue here work in the main
Hospital away from the business and personnel offices. By contrast, Lincoln Park Nursing
Home, 318 NLRB 1160, 1163-1164 (1995), although not involving an acute care hospital, is
more on point. In that case, the Board included the nursing department payroll clerk in the
service and maintenance unit. The payroll clerk was responsible for, inter alia, scheduling
employees on a master schedule and meeting staffing quotas, and tallying employees’ hours from
their time card and submitting this information to the business office. The Board reasoned that
the payroll clerk and other included secretaries did not perform functions associated with BOCs,
were not grouped in isolation from other nonprofessionals (unlike BOCs described in
rulemaking), and therefore fit within the “‘other types of clericals’” (id. at 1164) classifications
that have traditionally been included in the service and maintenance units, even though they did
not perform work closely related to the functions performed by employees in the service and
maintenance unit. Ibid.20 Here, too, the Coordinators do not perform functions associated with

Service. Works collaboratively with the Human resources/payroll department, Specialty Nursing
Service Coordinators and Nursing Administration.”
19 The record indicates that the Coordinators also report to the House Supervisor, who is part of
the nursing department and engages in placing patients in the correct beds and ensuring adequate
staffing. There is no contention, however, and the evidence does not establish, that the House
Supervisor is a statutory supervisor.
20 See also Duke University, 226 NLRB 470, 471 (1976) (in including those secretaries and
clerks in the service and maintenance unit who did not physically work in the business office, the
Board found that that they spent a majority of their work time “devoted to activities that are
imminently connected with and functionally related to the Employer’s health care objectives”,
and that “[w]hile some of them may perform…functions which are similar to duties performed in
8
BOCs and are not grouped in isolation from other nonprofessionals. Rather, they work in the
main hospital under the general umbrella of nursing operations, interact and share common
supervision with unit employees, and perform functions instrumental to patient care.
Accordingly, we include the Coordinators in the unit.

Specialists HIM Data Integrity:
As background, Health Information Management (HIM) is a department that maintains and
controls the medical records of all patients admitted to the Hospital. The Director of HIM
ensures privacy and the accuracy of the medical records, and oversees the collection and
completion of these records and their retention.
The Specialists HIM Data Integrity monitor and repair patient identity issues so that the
correct patient is identified for billing purposes, and also review certain insurance claims that
have been denied.21 The record shows that a patient may be misidentified (such as a father and
son with the same full name) when the patient arrives at the Hospital and upon registration, and
incorrect information can be put into that patient’s medical record. It is the Specialist’s
responsibility to desegregate those records and put them in the appropriate medical record
electronically. A patient identity issue could be identified by nursing personnel as they are
treating the patient, and the nurse would contact the Specialist about a potential identity issue. If
an insurance claim is denied because of potential documentation issues or the incorrect service
type was chosen when the patient was registered, the Specialists review the chart and the
registration process after notification from the supervisors at the Central Billing Office that a
claim was denied for a particular reason, and ensure the patient was accurately assigned to the
correct service type. The Specialists then inform the supervisors at the Central Billing Office of
their findings. The Specialists’ duties are unrelated to actual patient or insurance billing, as their
responsibility is simply to correct the patient’s account to ensure that the correct patient is
identified or that the service type is correct.
The Board has generally found medical records employees not to be BOCs, but rather hospital
clericals, based on factors such as their work location, contact with service and maintenance
employees and physicians, and the relationship of their clerical functions to patient care. See,
e.g., Rhode Island Hospital, 313 NLRB at 362-363; Baptist Memorial Hospital, 225 NLRB

the business office, these duties are related to patient care.”); Trumbull Memorial Hospital, supra
at 796 (including clerks, typists and secretaries who worked in areas other than the employer’s
personnel, BOC, and other specified departments).
21 According to their job description, the Specialists HIM Data Integrity 1) are responsible for
ongoing monitoring and repair of patient identity issues, duplicate medical record numbers, and
patient overlays; 2) actively collaborate with end users to resolve issues and ensure that
appropriate documentation errors are corrected; 3) may review insurance payments and denials
and recommend billing corrections; 4) participate in initiatives related to the legal health record,
all supporting systems, and developing policy and procedures related to data integrity and the
legal health record; and 5) are subject matter experts on all systems impacting the legal health
record and participate in system design, validation, and testing.
9
1165, 1168 (1976); William W. Backus Hospital, 220 NLRB 414, 415 (1975); St. Catherine’s
Hospital of Dominican Sisters of Kenosha, 217 NLRB 787, 789 fn. 20 (1975). However, the
Board has also included medical records employees in BOC units, considering such factors as
their isolation from unit employees and whether their functions were integrated with patient
account services. See St. Luke’s Episcopal Hospital, 222 NLRB at 677; Seton Medical Center,
221 NLRB 120, 122, fn. 21 (1975).
The Regional Director, reversing the hearing officer, included the Specialists HIM Data
Integrity in the unit.22 Contrary to the Regional Director, and in agreement with the Petitioner,
we find that the Specialists from the unit are more akin to BOCs. In this regard, while the
Regional Director found that the Specialists ensure the integrity of patient health records and are
not involved with patient billing or insurance claims, it is also clear, as urged by the Petitioner,
that the Specialists work closely with supervisors in the Central Billing Office regarding
insurance denials and billing corrections. Thus, the corrections that they are involved with
appear to pertain to patient misidentification and billing and insurance matters, not patient care
issues. Further, although the Specialists apparently interact with unit employees when alerted
about possible errors and verifying information, the record does not detail the frequency or
extent of these interactions. In addition, the Specialists for the most part do not interact with or
work near patients,23 but rather work in the basement alongside other HIM employees. Finally,
we find that the exclusion of the Specialists is consistent with the Board’s finding, in agreement
with the Regional Director, that other Medical Records Technicians, who also work in HIM and
perform similar functions, are BOCs. See Order dated 12/15/17.24
Accordingly, we reverse the Regional Director and exclude the HIM Data Integrity
classification from the unit as a BOC position.
CONCLUSION

22 In the December 15, 2017 Order granting review in part in this case, the Board agreed with the
Petitioner that the Regional Director made a drafting error with respect to the Specialists HIM
Data Integrity by discussing them in two separate sections and making contradictory findings
regarding their status (sustaining the challenges on pages 5-6 but overruling the challenges on
page 10). After viewing the Supplemental Decision as a whole, the Board concluded that the
Regional Director intended to overrule their challenged ballots and that his inclusion of the
Specialists HIM Data integrity raised a substantial issue warranting review.
23 The Specialists may occasionally interact with patients when verifying information after an
issue regarding that patient has been identified.
24 Those medical records employees function as a contact point between medical records and
billing and their job is to correct patient records, review insurance payments, and recommend
billing corrections. In agreeing that the Medical Records Technicians were BOCs, the Board,
relying on St. Luke’s, supra, emphasized that they function as a contact point between medical
records and billing (including recommending billing corrections), and the evidence did not
establish that they work in patient care areas or have frequent or substantial contact with unit
employees in the course of performing their functions. While it appears here that the Specialists
may have more contact with unit employees than the Medical Records Technicians, the
evidence, as noted, does not indicate that this contact is substantial.
10
In sum, the Regional Director’s Supplemental Decision and Direction to Sustain Certain
Challenged Ballots and Count the Remaining Challenged Ballots is affirmed with respect to the
exclusion of the Employer’s 1) IT Clericals (Executive Secretary, Information Systems;
Enterprise Practice Management (EPM)-Electronic Medical Record Information System
(EMRIS) Specialist; System Analysts I, II, III; Software Engineers III; Applications Specialist
Materials Manager; Healthcare Intelligence Architect; Clinical Support Liaisons, Information
Services; System Engineers I, II, III; Helpdesk Technicians; Desktop Engineers; Network
Engineers; EPM (Enterprise Practice Management) Specialist; Senior Security Administrator;
and Infrastructure Technician), 2) Workers Compensation Claims Specialist, 3) Education
Coordinator, and 4) Telecommunications Technician. The Regional Director’s Supplemental
Decision is also affirmed with respect to the inclusion of the Applications Specialist and
Application Specialist, Perioperative. The Regional Director’s Supplemental Decision is
reversed with respect to the exclusion of the Nursing Service Systems Analysts, Charge Revenue
Representatives, System Coordinator Laboratory, and Nursing Staff Coordinators, and the
inclusion of the Specialist HIM Data Integrity.
ORDER
This proceeding is remanded to the Regional Director for Region 21 for further appropriate
action consistent with this Decision on Review and Order, including, as soon as practicable
thereafter, from the date of this Decision and Order, opening and counting the ballots of the
Applications Specialist; Application Specialist, Perioperative; Nursing Service Systems
Analysts; Charge Revenue Representatives; System Coordinator Laboratory; and Nursing Staff
Coordinators. The Regional Director shall serve on the parties a revised tally of ballots and issue
the appropriate certification.

JOHN F. RING, CHAIRMAN
LAUREN McFERRAN, MEMBER
MARVIN E. KAPLAN, MEMBER
Dated, Washington, D.C., January 11, 2019.