JOB TITLE: FACILITY REIMBURSEMENT MANAGER

JOB CODE: 08625

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 managerial and administrative work directing and controlling financial reimbursement activities for an assigned group of facility reimbursement offices.

An employee in this job directs, through subordinate Facility Reimbursement Officers, the financial reimbursement activities for an assigned geographic region. Work involves assessing billing practices and collection methods for efficiency, effectiveness, and maximization of reimbursements; implementing and measuring improvements in collection policies and practices; performing on-site reviews of billing and collection activities to ensure all applicable policies, procedures, and laws are followed; and providing guidance and training to reimbursement offices. Administrative and technical supervision is provided by a higher level administrator who monitors, reviews, and evaluates the work performed for results achieved.

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, manages, and participates in financial reimbursement activities at two or more assigned state operated facilities.

Manages 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.

Meets with individuals and their guardians, their relatives, their liable representative payees, and facility administrators to discuss and resolve sensitive problems pertaining to individuals’ home, health care, and related maintenance services costs.

Reviews individuals’ accounts and reimbursement records including accounts receivable, various control accounts, abatements, and other types of accounts to ensure accuracy.

Reviews assessment practices, billing and collection techniques, accounting procedures, and various reports to ensure all charges and accounting adjustments are accurate.

Reviews and approves or disapproves accounting adjustments.

Reviews uncollectable accounts and other problem accounts with facility administrators to develop alternative reimbursement plans.

Notifies appropriate authorities of uncollectible individuals’ accounts.

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

Identifies problematic trends in statistical data such as delinquent accounts reports, census information, billing charges reports, and collections data.

Provides various reports including accounts information, reimbursements levels, dispensed health care, and other information to external and internal auditing entities.

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

Provides on-site guidance and training to facility reimbursement staff, or arranges for same.

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 operations.

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

Knowledge of interviewing techniques.

Knowledge of the principles and practices of employee supervision.

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

Ability to analyze written information and numerical data.

Ability to maintain effective working relationships.

Ability to communicate effectively orally.

Ability to communicate effectively in writing.

FULL PERFORMANCE KNOWLEDGES, SKILLS, AND ABILITIES: (NOTE: These are expected of an employee performing the work of this job at the full performance level. These may not be evaluated by the State Civil Service Commission or used for Civil Service examination purposes and are not position-specific performance standards.):

Knowledge of veterans’ benefits, other health care benefit programs, and/or county liability for individuals’ health care and maintenance costs.

Knowledge of health care cost reimbursement processes applicable to all parts of Medicare, Medicaid, retirement funds, Social Security, and private health care insurances.

Knowledge of Shared Medical Systems coding used in Department of Human Services facilities and/or veterans extended care facilities.

Knowledge of departmental reimbursement office rules, regulations, and policies.

Knowledge of patient encounter data collection systems used by physicians, utilization review staff, and administrators.

Knowledge of per diem rates appropriate for the levels of health care provided.

Knowledge of court proceedings and magistrates’ hearings related to estate settlements.

Ability to determine and implement billing charges for new health care services which result from the introduction of new diagnostic procedures, equipment, and reimbursement programs.

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

One year of experience as a Facility Reimbursement Officer;

                                                                                                                                                     or

Six years of experience involving public contact in billing and collecting financial accounts or debts which includes one year of supervisory experience in billing and collecting financial accounts or debts;

                                                                                                                                                    or

Any equivalent combination of experience and training which includes one year of supervisory experience in billing and collecting financial accounts or debts. 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 non-supervisory 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.