2903-Hospital Eligibility Worker

Job description

CITY AND COUNTY OF SAN FRANCISCO

DEPARTMENT OF HUMAN RESOURCES

Title: Hospital Eligibility Worker

Job Code: 2903

INTRODUCTION

Under general supervision, performs a variety of technical duties in the screening, determination of patient eligibility, and enrollment for medical coverage under the terms of various private and public health care and financial assistance programs.

DISTINGUISHING FEATURES

Positions in this classification are responsible for carrying out well defined rules and regulations pertaining to screening and enrolling patients in various categorical aid programs; explaining the provisions of various health care programs to patients and the general public; and determining eligibility for appropriate payor sources for medical treatment. Positions in this class have regular contacts with patients, their relatives, hospital personnel, and representatives of outside agencies and the public.

2903 Hospital Eligibility Worker is the journey level class and is distinguished from the 2908 Senior Hospital Eligibility Worker in that the latter performs financial counseling, screening and enrollment for medical coverage for comprehensive aid programs such as Medi-Cal. The 2903 Hospital Eligibility Worker is distinguished from the 2905 Human Services Agency Senior Eligibility Worker in that class 2903 identifies and determines patient eligibility for medical coverage under the terms of various public and private health plans and financial assistance programs, whereas class 2905 determines client eligibility for public assistance and certifies for reimbursement under the terms of various social service programs.

SUPERVISION EXERCISED

MAJOR, IMPORTANT, AND ESSENTIAL DUTIES

According to Civil Service Commission Rule 109, the duties specified below are representative of the range of duties assigned to this job code/class and are not intended to be an inclusive list.

1. Interview patients, their relatives and others to obtain financial and demographic information and determine eligibility for coverage of medical care under various Federal, State or County programs or under the provisions of private or public health care plans; verify insurance and arrange for billing of the appropriate agency or health care plan.

2. Admit and register patients for clinic and hospital services; initiate referrals for incoming skilled or long term care patients.

3. Coordinate transfers of patients between medical facilities; inform patients of procedures and necessary reports.

4. Explain eligibility programs, qualification standards, policy and procedure to patients; assist patients in completion of applications, forms and reports when necessary; review and evaluate applications for completeness and accuracy; prepare patient budget to determine eligibility.

5. Prepare records related to patient eligibility information and financial assistance received; update records; submit required reports.

6. Investigate statements and information received from applicant through the use of telephone or written verifications.

7. Investigate and resolve patient questions and concerns regarding clinic and hospital bills.

8. Review cases with supervisor in assessing the quality of the payment source determination process and procedure.

9. Compose and prepare correspondence to patients, references, and State agencies; gather statistical data and prepare reports as required.

10. Answer questions and provide information to patients and the general public regarding assigned program area.

11. Perform related duties as required.

IMPORTANT AND ESSENTIAL KNOWLEDGES, SKILLS, AND ABILITIES

Knowledge of: Basic interviewing and investigative skills and techniques; principles and practices of caseload management; Federal, State, local laws, rules, regulations, policies, and procedures regarding assigned program area; services offered by related agencies; departmental programs, policies, procedures and terminology; office procedures, methods and computer equipment; basic mathematics.

Ability to: Interview applicants for public assistance and obtain appropriate information, often in different languages, or dialects of English; accurately gather, record and evaluate data necessary for the determination of eligibility; interpret and apply Federal, State and local policies, procedures, laws and regulations; maintain accurate records and meet program deadlines; operate a computer terminal and standard office machines; make accurate mathematical computations; type and enter data at a speed necessary for successful job performance; effectively communicate with and elicit information from patients in difficult situations; communicate clearly and concisely, both orally and in writing; establish and maintain cooperative working relationships with those contacted in the course of work.

MINIMUM QUALIFICATIONS

These minimum qualifications establish the education, training, experience, special skills and/or license(s) which are required for employment in the classification. Please note, additional qualifications (i.e., special conditions) may apply to a particular position and will be stated on the exam/job announcement.

1.Two (2) years of direct public contact clerical work experience which must have included the following: use of computer applications to input, retrieve and analyze information; working with a diverse client population; performing responsibilities involving interviewing to acquire detailed personal or confidential information; interpreting and applying rules, regulations and policies; creating and processing documents related to financial or personal histories of clients; and assisting clients with the completion of forms or correspondence;

OR

2.One (1) year of experience determining eligibility for health and/or social services programs, loans, financial assistance, unemployment or veterans benefits:

OR

3.Sixty (60) semester units or ninety (90) quarter units from an accredited college or university.

Substitution: Thirty (30) semester units or forty-five (45) quarter units from an accredited college or university may substitute for one (1) year of the work experience under qualification pattern number one (1) above.

LICENSE AND CERTIFICATION

SUPPLEMENTAL INFORMATION

PROMOTIVE LINES

ORIGINATION DATE: 2/13/1968

AMENDED DATE: 1/17/1972; 3/15/1993; 9/5/2014; 11/12/2014

REASON FOR AMENDMENT To accurately reflect the current tasks, knowledge, skills and abilities defined in the most recent job analysis conducted for this job code.

BUSINESS UNIT(S): COMMN

Standard information

Disaster service work

All City and County of San Francisco employees are designated Disaster Service Workers through state and local law (California Government Code Section 3100-3109). Employment with the City requires the affirmation of a loyalty oath to this effect. Employees are required to complete all Disaster Service Worker-related training as assigned, and to return to work as ordered in the event of an emergency.

Historic and future compensation