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Commonwealth of Pennsylvania |
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POSITION DESCRIPTION FOR JOB POSTING |
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Position Number: 00063087 |
Description Activated On: 6/1/2026 4:06:30 PM |
Position Purpose: Describe the primary purpose of this position and how it contributes to the organization’s objectives. Example: Provides clerical and office support within the Division to ensure its operations are conducted efficiently and effectively. Supervises daily operations of the Reimbursement Office at Clarks Summit State Hospital in accordance with Department of Human Services (DHS) and other applicable rules, regulations, policies, and procedures which govern charging, collecting, and accounting for reimbursements from care and maintenance provided to hospitalized individuals. |
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Description of Duties: Describe in detail the duties and responsibilities assigned to this position. Descriptions should include the major end result of the task. Example: Types correspondence, reports, and other various documents from handwritten drafts for review and signature of the supervisor. Approval of all determination of liability, accounting transactions, and official reports, performing on-site reviews, analyzing reimbursement functions, and recommending corrective action to maintain compliance with established policies and procedures and to maximize reimbursement. Supervises staff who investigate the resources and benefits of newly admitted consumers at Clarks Summit State Hospital. After research is complete, Federal and State Regulations will be applied to the findings to determine a consumer's maximum liability for care and maintenance while residing at the facility. The position is responsible for staff who bill resources such as Medicare, Medicaid, Insurance, Representative Payees, Guardian offices, etc. The person in this position will help to maximize revenue for Clarks Summit State Hospital and the Commonwealth by updating/contacting outside departments and agencies when needed. The person will foster good public relationships with inter-hospital disciplines, the Guardian Office, Federal, State, and County governmental agencies, intermediaries, and other payers. Keeps staff aware of all applicable DHS personnel and labor-management policies, procedures, and agreements. Assigns work giving attention and importance to employee’s civil service classification and demonstrated abilities. Implements/exercises/maintains the DHS Employee Performance Evaluation system. Enforces DHS timekeeping, leave, absenteeism, and disciplinary programs. Complies with applicable labor-management agreements. Routinely reviews all personnel issues and problems with the Facility Reimbursement Manager. Exercises personnel management initiatives such as recognizing subordinate accomplishments, recommending promotion or demotion, initiating discipline, and deciding grievances at the appropriate step. Ensures financial liability of hospitalized individuals their relatives and/or counties. Ensures individual/family interviews. Obtains financial data on income(s), benefit(s), and assets via resource investigation. Applies appropriate deductions and/or exemptions as defined by DHS regulations and sets liability. Maintains confidentiality over financial data obtained/derived. Ensures proper accounts classifications for billing. Participates in fair hearings as conducted by the Bureau of Hearings and Appeals (BHA). Ensures accounting for services rendered and reimbursements received is performed in accordance with Departmental rules by: Ensures timely billing Ensuring payments are promptly and properly posted to the daily Cash and Check Control. Examines/authenticates payment receipts. Ensuring prompt deposit of payments and timely transmittals of deposit information to the DHS comptroller. Following-up in writing and/or by telephone to include dunning. Resolving benefit application problems. Fostering good public relationship with inter-hospital disciplines, the Guardian Office, Federal, State and County governmental agencies, intermediaries, and other payers. Prepares tri-annual budgetary estimates and periodic projections of revenue as required by DHS. Renders reports and provides interpretative analysis when and as required by DHS policies. Reviews/acts upon all mail received in the Facility Reimbursement Office. Ensures responses and maintains an up-to-date, effective filing system. Attends meetings, training sessions and job-related seminars and maintains routine contact with the Facility Reimbursement Manager in order to keep abreast of the latest managerial and operational developments affecting reimbursement programs. Refers, as appropriate, delinquent account information to the Governor's Office of General Counsel (OGC) via the ROS central office. Performs other related duties and special projects as assigned, with purpose and standards to be given at the time of each assignment. |
Decision Making: Describe the types of decisions made by the incumbent of this position and the types of decisions referred to others. Identify the problems or issues that can be resolved at the level of this position, versus those that must be referred to the supervisor. Example: In response to a customer inquiry, this work involves researching the status of an activity and preparing a formal response for the supervisor’s signature. Decisions are based on existing policy and procedures as outlined in the Facility Reimbursement Operations Manual (FROM) in conjunction with current DHS policy, Commonwealth statutes and labor-management agreements. Issues not covered by these resources are referred to the Facility Reimbursement Manager and the ROS Administrator for resolution. |
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Requirements Profile: Identify any specific experience or requirements, such as a licensure, registration, or certification, which may be necessary to perform the functions of the position. Position-specific requirements should be consistent with a Special Requirement or other criteria identified in the classification specification covering this position. Example: Experience using Java; Professional Engineer License Experience: Licenses, registrations, or certifications: 1. N/A 2. N/A 3. N/A 4. 5. 6. |
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Essential Functions: Provide a list of essential functions for this position. Example: Transports boxes weighing up to 60 pounds.
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