JOB TITLE: FACILITY REIMBURSEMENT OFFICER

JOB CODE: 08620

SERIES NATURE OF WORK:

The Facility Reimbursement job series describes work in identifying and collecting financial reimbursements for costs related to providing care to individuals residing at state operated facilities.

DEFINITION:

This is technical, administrative, and supervisory work in billing, collecting, and controlling the acquisition of financial reimbursements for the cost of provided home, health care, and related maintenance services.

An employee in this job investigates and determines individuals’ eligibility for a variety of benefits to defray the cost of home, health care, and related maintenance services expenses. Work involves supervising clerical and technical reimbursement staff; determining individuals’ financial liability for home, health care, and related maintenance services expenses; determining individuals’ financial resources and eligibility for benefits to cover those expenses; assessing costs based on the levels of provided care and providing calculations of costs for facility budgetary projections; billing and collecting funds from a variety of health care benefit resources such as Medicare and Medicaid; collecting and depositing collected funds into state and federal accounts; and acting as the administrator for individuals’ estates. Work may also involve supervising clerical employees performing work in admission, discharge and/or data processing work. Administrative and technical supervision is provided by a Facility Reimbursement Manager who monitors, reviews, and evaluates the work performed for results achieved.

   DISTINGUISHING CHARACTERISTICS:

Work is distinguished from the Facility Reimbursement Technician by the responsibility to supervise Facility Reimbursement Technicians; determine individuals’ financial liability for home, health care, and related maintenance services expenses; and serve as administrators for residents’ estates.

In the Department of Military and Veterans Affairs, work is also distinguished from the Facility Reimbursement Technician by the responsibility to assist individuals in applying for veterans’ benefits.

EXAMPLES OF WORK: (NOTE: The examples of work are representative of the work, but every position classified to this job may not perform all examples of work listed. Conversely, this is not an all-inclusive list of work examples.):

Plans and supervises reimbursement activities at a state operated facility.

Bills and controls the acquisition of funds from a variety of sources such as all parts of Medicare, Medicaid, veterans’ benefits, Social Security, railroad settlement, private insurances, and/or liable representative payees or counties.

Determines individuals’ assets and their ability to pay for their health care costs through interviews with liable representative payees, guardians, or third party payors.

Contacts or travels to offsite locations to gather information from courthouses, county assistance offices, banks, Social Security offices, various retirement funds, and health care insurance carriers to determine individuals’ eligibility for health care benefits.

Assists eligible individuals in obtaining financial support and health care benefits from various sources including all parts of Medicare, Medicaid, Social Security, veterans’ benefits, private pensions, health care insurance providers, and other sources.

Determines the sequence and methods for billing health care financial resources.

Bills health care benefit resources for individuals’ home, health care, and related maintenance services costs.

Collects full or partial payments, or recommends approval for the abatement of home, health care, and related maintenance services costs.

Notifies appropriate authorities of uncollectible individual health care accounts.

Reviews admission, discharge, and outpatient care data for accuracy and to determine charges based on the level of provided health care.

Maintains multiple ledgers to account for individuals’ health care funds, accounts receivable, various control accounts, abatements, and other types of accounts.

Prepares various financial and statistical data such as delinquent accounts reports, census information, billing charges reports, and collections data.

Represents the commonwealth at court proceedings or magistrates’ hearings relative to liability assessments, delinquent accounts, estate settlements, and write-off requests.

Performs the full range of supervisory duties.

Employees in this job may participate in the performance of subordinates’ work consistent with operational or organizational requirements.

Performs related work as required.

ENTRY LEVEL KNOWLEDGES, SKILLS, AND ABILITIES:

Knowledge of the principles and practices used in the determination of financial resources and benefits.

Knowledge of the principles and practices utilized in financial billing and collection 6operations.

Knowledge of the principles and practices utilized in the maintenance of individual financial account records and files.

Knowledge of basic mathematical calculations, such as addition, subtraction, multiplication, and division.

Ability to maintain effective working relationships.

Ability to communicate effectively orally.

Ability to communicate effectively in writing.

MINIMUM EXPERIENCE AND TRAINING: (NOTE: Based on the Entry Level Knowledges, Skills, and Abilities):

Two years of experience as a Facility Reimbursement Technician;

                                                                                                                                                         or

Five years of experience involving public contact work in billing and collecting financial accounts or debts;

                                                                                                                                                        or

Any equivalent combination of experience and training. Completion of college-level work with major course work in business administration, finance, accounting, health care management, or a related field may be substituted for required experience on a year-for-year basis.

SPECIAL REQUIREMENTS:

All positions in the Department of Military and Veterans Affairs require valid accreditation by the U.S. Department of Veterans Affairs as a veterans service officer or eligibility for accreditation within one year from the date of employment.

Certain positions require possession of a valid Pennsylvania non-commercial class C driver’s license or equivalent.