Bargaining Unit: SEIU 1021 - Eligibility Techs (006)
$29.49-$34.94 Hourly / $2,211.75-$2,620.50 BiWeekly /
$4,792.13-$5,677.75 Monthly / $57,505.50-$68,133.00 Yearly
Under general supervision, to advise and counsel clients, families, hospital and clinic staff regarding patients' financial obligations with reference to financial resources; to initiate documentation for the purpose of maximizing revenue, including patient preliminary applications for various governmental medical or financial aid programs; and to do related work as required.
Incumbents of positions in this class receive specialized training in determining appropriate medical benefits based on client’s financial resources, screen for eligibility for financial aid and ensure submission of appropriate documentation. Incumbents must be knowledgeable in all aspects of government regulations and procedures to establish, receive and distribute benefits. The class is distinguished from Specialist Clerk positions in that the latter collects information to be used in the determination of the payment source. The function of the Patient Services Technician I is to establish the payment source(s), verify it and set up a payment plan. Patient Services Technician I’s normally promote to Patient Services Technicians II after six months of experience. Patient Services Technician II’s are expected to independently complete financial screenings and process related documentation, including complex and unusual cases, subject to review by the Patient Services Supervisor.
EXAMPLES OF DUTIES
NOTE: The following are the duties performed by employees in this classification. However, employees may perform other related duties at an equivalent level. Each individual in the classification does not necessarily perform all duties listed.
1. Interprets provisions and requirements of Federal, State and County aid programs and explains to clients their rights and obligations.
2. Gathers and analyzes client information on financial circumstances, residence status, duration and types of care in order to determine the client’s potential eligibility for a variety of governmental programs, including Medi-Care and Medi-Cal; initiates the necessary documents within time limits specified by the appropriate Agency for obtaining benefits.
3. Counsels clients and families regarding their responsibility to reimburse the County for medical care; interviews clients, relatives, attorneys, employers, and governmental agencies to obtain information, explain County policy, secure payments and arrange payment plans.
4. Identifies whether clients have third party payee insurance and initiates documents for claiming benefits.
5. Informs and advises medical providers of the client’s eligibility and/or financial status according to established regulations.
6. Counsels clients and families about utilizing available resources and programs when appropriate; identifies problem situations and makes appropriate referrals to other departments and County agencies.
7. Advocates for clients, resolves complex problems involving the interface of various private and governmental resources to assure billing and maximum reimbursement to the County.
8. Inputs accurate financial data into applicable computer information systems in a timely manner.
The equivalent of one year of full-time experience in a class equivalent to or higher than Specialist Clerk that included experience in determining financial eligibility for aid programs or similar type experience related to Medi-Cal, Medi-Care, Social Security Supplemental Income, or Social Security Disability Benefits.
The equivalent of two years’ full-time clerical experience that must have included at least one year of experience in a hospital related unit involving determination of financial eligibility or medical billing work for medical assistance through personal interview. This would include making inquiries with other public and private agencies in order to verify/obtain medical benefits.
NOTE: The Civil Service Commission may modify the above Minimum Qualifications in the announcement of an examination.
KNOWLEDGE AND SKILLS
NOTE: The level and scope of the following knowledge and abilities are related to duties listed under the “Examples of Duties” section of this specification.
• Hospital admitting financial requirements.
• Hospital/clinic fiscal procedures.
• General program requirements for Medi-Cal, Medi-Care, Social Security Supplemental Income, Social Security disability benefits and other regulations.
• Modern business office equipment, procedures and methods.
• Comprehend, interpret and follow complex instructions related to governmental medical assistance programs.
• Obtain appropriate eligibility and financial information from clients.
• Analyze and problem solve to evaluate individual situations, reach sound conclusions, and make appropriate recommendations.
• Keep abreast of changes in Medi-Care and Medi-Cal and other regulations as they relate to financial and program eligibility.
• Advocate for client to resolve discrepancies/inconsistencies related to client benefits and/or their accounts.
• Exercise decision making and judgment to assess a situation, consider alternatives and choose an appropriate course of action.
• Plan and organize work.
• Exercise interpersonal sensitivity to function with a specialized population, co-workers and others.
• Work under pressure and meet deadlines.
• Work independently and adapt to change.
• Perform complex clerical work and use various computer systems.
• Make accurate calculations and computations.
• Communicate effectively orally and in writing.
• Establish and maintain cooperative working relations with those contacted in the course of work.
• Function effectively within a hospital or clinic environment.
• Type 40 words per minute.
CLASS SPEC HISTORY
JG-S:gcm Revised 7/80
DW:Lm-h Revised 4/84
TMZ:pb Updated: 9/20/89
DF:jc Revised: 8/21/97
AM:jc Revised 6/98
Old document: 0190h.doc
BG:pf Rev. 9/12/00
New document: Jobspecs/1496
CSC Date: 10/25/00
Alameda County offers a comprehensive and competitive benefits package that affords wide-ranging health care options to meet the different needs of a diverse workforce and their families. We also sponsor many different employee discount, fitness and health screening programs focused on overall well being. These benefits include but are not limited to*:
For your Health & Well-Being
For your Financial Future
For your Work/Life Balance
*Eligibility is determined by Alameda County and offerings may vary by collective bargaining agreement. This provides a brief summary of the benefits offered and can be subject to change.