Official SealSan Joaquin County Human Resources Division


#0319-RH0301-01
Supplemental Questionnaire

Last Name
First Name
1

Please indicate if you have been or are currently employed by San Joaquin County in the classification of Patient Services Representative.

Yes, I am currently employed by San Joaquin County as a Patient Services Representative.
Yes, I have been employed by San Joaquin County as a Patient Services Representative.
No, I have not been employed by San Joaquin County in the classification of Patient Services Representative. (If selected, please go to question #2)
1a

If you responded yes, please identify:

  • Your dates of employment
  • Hours worked per week
  • County department

Note: This information should be clearly identified in the Employment Experience section of the application.

2

If you responded no to question #1, do you possess at least three (3) years of full-time (40 hours per week) paid experience determining patient financial eligibility and resources in a health care setting.

Yes No
2a

If you responded yes to the previous question, please clearly identify the programs and resources you researched, offered, or provided for patients.

If you do not possess any of this experience, indicate "None" in the answer space below.

2b

Provide a detailed description of your role in determining a patient's financial eligibility for healthcare programs and resources. Include in your response the following:

  1. The reason or purpose of the patient's visit to the facility for services
  2. What paperwork or forms, if any, you assisted the patient in completing
  3. The eligibility tools used to determine a patient's ability to pay and/or receive medical financial resources
  4. Your role in following up with the patient after the initial contact
3

Please describe your experience leading or mentoring staff. (If no experience, please indicate "None" in the space below).