Reimbursement Officer I Class Specification

DEPARTMENT OF CENTRAL MANAGEMENT SERVICES CLASS SPECIFICATION

REIMBURSEMENT OFFICER I

POSITION CODE: 38199

Effective: 12-1-02

DISTINGUISHING FEATURES OF WORK:

Under general supervision, performs a variety of professional reimbursement duties; investigates the financial liability of patients, their estates and their legally responsible relatives; conducts field investigations to acquire pertinent patient data; prepares and/or assists in the preparation of various types of correspondence used to expedite collection of funds; conducts personal interviews with patients, their relatives and other involved representatives to complete patient's files; explains statutes, policies and procedures relevant to the reimbursement program; confers with supervisor concerning the more complex cases; maintains and reviews recipient's files; assists in training reimbursement personnel and other staff in reimbursement operations.

ILLUSTRATIVE EXAMPLES OF WORK:

  1. Investigates and evaluates the financial liability of patients, their estates and their legally responsible relatives in order to determine an equitable schedule of charges for care and treatment; reviews patients' assets, benefits, insurance coverage and other relevant documents.
  2. Conducts field investigations to procure relevant information needed in determining the financial liability of patients, their relatives and other involved parties for care and treatment; obtains copies of wills, deeds, birth certificates and other pertinent patient documents; checks court records relevant to reimbursement claims.
  3. Confers with relatives, attorneys, legislators and other involved parties to acquire information in assuring the proper handling of recipient's funds.
  4. Explains schedules of charges, policies and procedures relevant to the reimbursement program.
  5. Assists State's Attorney in filing reimbursement claims; testifies, when requested, at court proceedings pertinent to the recovery of reimbursement monies.
  6. Prepares reports, forms and other correspondence relevant to reimbursement operations; prepares legal correspondence on delinquent claims necessitating court action.
  7. Assists supervisor in training reimbursement personnel in the methods and procedures followed within the facility.
  8. Reviews reimbursement accounts periodically; removes files of discharged patients; closes-out files of deceased patients; determines if charges warrant adjustments.
  9. Prepares the data processing control forms indicating the appropriate adjustments made to the patient's account.
  10. Provides instruction to other agency staff in the proper techniques used in acquiring patient information.
  11. Performs other duties as required or assigned which are reasonably within the scope of the duties enumerated above.

DESIRABLE REQUIREMENTS:

Education and Experience

Requires knowledge, skill and mental development equivalent to completion of four years of college, with courses in accounting, economics or business administration, preferably including courses in insurance, estate and probate law.

Requires one year of work experience in the reimbursement field.

Knowledges, Skills and Abilities

Requires working knowledge of the principles of hospitalization and life insurance.

Requires working knowledge of legal terminology relevant to the reimbursement of funds.

Requires working knowledge of the Federal Health Care Law as it pertains to recipients at State facilities.

Requires extensive knowledge of various reimbursement forms utilized by the facility.

Requires extensive knowledge of the statutes and departmental policies, rules and regulations as they relate to the reimbursement of monies to the State for the care and treatment of patients.

Requires extensive knowledge of mathematical calculations relevant to reimbursement funding.

Requires extensive knowledge of the filing system used in the reimbursement program.

Requires ability to analyze records, accounts, forms and legal documents to ascertain financial condition, completeness, accuracy and sufficiency in compliance with State laws and departmental rules and regulations.

Requires ability to evaluate provisions of life, hospitalization and other insurance documents.

Requires ability to effectively communicate, to a wide range of people, procedures, methods and/or laws pertaining to the reimbursement program.

Requires ability to analyze and appraise facts presented in legal documents and records for the purpose of determining charges.

Requires ability to update and maintain complex reimbursement records.

Requires ability to make varied mathematical calculations.

Requires ability to prepare complex reports relevant to reimbursement operations.

In addition to English verbal and written skills, candidates may be required to translate, speak and write a foreign language at a colloquial skill level. Some positions may require manual communication skills.