Class Specification: PATIENT RESOURCES WORKER
ITEM NUMBER: 9192
APPROVAL DATE: 10/18/2012
Identifies patients' financial resources to pay for medical and/or mental health care and services; and assists patients in making assignments for medical benefits, and completes standardized billing forms based upon data acquired.
Positions allocable to this class typically report to a Supervising Patient Financial Services Worker I. Positions in this class identify third-party resources by interviewing patients or their relatives and/or representatives to determine patient's financial resources to pay for medical and/or mental health care services by using electronic information systems. Positions in this class assist patients to determine their potential eligibility to enroll in health care programs, obtain patient signatures on benefit assignment forms to assign and authorize payment of insurance benefits directly to the County, and process applications for a variety of no-cost/low-cost health care programs, such as Outpatient Reduced-Cost Simplified Application (ORSA), Ability To Pay (ATP), and Uniform Method of Determining Ability to Pay (UMDAP). Patient Resources Workers are distinguished from Patient Financial Services Workers (PFSW) in that Patient Resources Workers screen and refer patients with Medi-Cal linkage to PFSWs for further eligibility determination and screening; and from incumbents of the Intermediate Clerk and the Intermediate Typist-Clerk classes who may direct the patient, relative, and/or authorized representative for financial screening.
EXAMPLES OF DUTIES:
Interviews patients or their relatives and/or representatives to obtain identifying information, financial and other eligibility data; determines the patient's potential eligibility to enroll in specific health care programs based upon diagnosis, available medical information, type of medical/clinical services, and residency status; enters and accesses data by utilizing various local and web-based information systems and databases to determine a patient's financial eligibility.
Evaluates financial data and resources to determine the patient's ability to reimburse the County for medical and/or mental health care services consistent with department policy; completes or assists the patient in the completion of benefits forms for third party resources; contacts private insurance companies to verify coverage and to obtain authorization for services; verifies existing governmental coverage for medical or mental health care, and screens for the patient's potential eligibility to receive Medi-Cal or other no-cost/low-cost programs.
Communicates with patients, responsible relatives and/or representatives, attorneys, employers, agencies and insurance companies to explain County policies and to obtain, verify, or clarify information required to complete standardized billing forms. Computes plans of payment for patients whose medical share of cost has already been established.
Completes required federal, State, and County forms for patients during emergency room visits, upon admission, and during outpatient clinic visits.
Refers patients without existing financial resources or with complex financial eligibility issues to a Patient Financial Services Worker or appropriate facility staff member.
Initiates and/or processes applications for a variety of reduced no-cost/low cost programs, such as ORSA, ATP, and UMDAP.
TRAINING AND EXPERIENCE:
Two years of experience interviewing the public to initiate or complete applications for financial assistance, credit, insurance, medical, mental health, hospital services, social security, or workers' compensation -OR- Three years of clerical experience, two years of which must have involved public contact associated with the financial screening and/or registration of patients or claims billing and collection for hospital or medical services -OR- Two years of experience involving public contact in the investigation and collection of accounts receivable -OR- Completion of 60 semester units earned in an accredited college or university.
A valid California Class C Driver License or the ability to utilize an alternative method of transportation when needed to carry out job-related essential functions.
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