Under supervision, interviews and determines eligibility for patients admitted to the hospital to assure that the County will receive appropriate reimbursement from patients and third party payers for inpatient service; and does related work as required.
CLASS CHARACTERISTICS
An employee in this class is responsible for maintaining a specific group of patient accounts for determining a patient’s eligibility for payment options. The incumbent is responsible for assuring that all material needed to bill a third party carrier and patient payment agreements sufficient to assure resolution of each account are established prior to transfer to the Patient Billing Section. An incumbent exercises considerable independence of action and judgement.
TYPICAL DUTIES
Interviews patients and relatives or guardians to obtain pre-admission information; admits patients by completing appropriate forms and procedures.
Conducts a financial evaluation of each patient to determine ability to meet financial obligations; based upon financial evaluation refers patients to Department of Public Assistance for Medi-Cal determination, if needed; established extended payment agreements.
Evaluates and verifies insurance coverage; completes insurance forms.
Maintains contact with admitted patients to monitor insurance coverage in order to assure that patients to monitor insurance coverage in order to assure that patients are transferred to appropriate programs when financial need arises.
Assures that discharged patients are interviewed before they are released if arrangements for settlement of the account have not been completed.
Assures that the discharge diagnosis is in each patient's account prior to its being sent to the Patient Billing Section.
MINIMUM QUALIFICATIONS
EITHER I
Experience: One year of experience as an Eligibility Worker I in San Joaquin County service.
OR II
Education: Completion 60 semester units from an accredited college or university with a major is liberal arts, business administration, social science, or closely related field.
Experience: One year of experience in credit or eligibility interviewing, or other comparable interviewing.
OR III
Experience: Four years of office clerical experience involving extensive public contact, two years of which must have been equivalent to Clerk II or a higher class in San Joaquin County service.
KNOWLEDGE
Interviewing and record keeping principles and techniques; standard office practices; fundamental aspects of human behavior.
ABILITY
Interview effectively; record and accurately evaluate data; communicate clearly and concisely, both orally and in writing; understand and follow complex oral and written instructions; maintain accurate and systematic records; establish and maintain effective working relationships with others; analyze and evaluate statements and other information obtained; draw logical conclusions and make proper recommendations.
PHYSICAL/MENTAL REQUIREMENTS
San Joaquin County complies with the Americans with Disabilities Act (ADA) and, upon request, will consider reasonable accommodations to enable individuals with disabilities to perform essential job functions.
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