Senior Health Services Representative

Job Overview Under general supervision, to provide lead supervision to a clerical staff engaged in a variety of work related to the registration and/or reimbursement process for clients to a patient care area or agency program service site throughout Santa Clara Valley Health & Hospital System. OR - Under general supervision, to perform a variety of complex, technical and specialized assignments related to the registration and/or reimbursement process for clients to a patient care area or agency program service site Santa Clara Valley Health & Hospital System. NOTE: Candidates that meet the employment standards will be invited to take an online examination scheduled for June 18, 2026. Qualifying candidates will be notified with examination instructions via the email address attached to their application. Responsibilities Provide lead supervision of a clerical staff engaged in a variety of work related to the registration process for clients to a patient care area or agency program service site throughout SCVH&HS. Perform routine as well as more technically difficult or complicated duties associated with the duties of a Health Services Representative. Assist in training, monitoring and guiding new employees. Assist in developing and/or revising internal procedures as they relate to the admission process of a particular department. Counsel and assist in selection decisions, performance evaluations and corrective action matters of subordinate personnel. Interpret and explain new or revised registration and clerical procedures to staff, clients, and other departments as appropriate. Communicate with various internal and external departments to provide/obtain accurate client information to complete the registration process. Perform related work as required. Process technically difficult or complicated financial screening and insurance authorizations or referrals associated with the duties of a Health Services Representative. Process difficult credit, collection or program application cases including out-of-county code Medi-Cal cases and Medi-Care exhausted accounts. Review and evaluate referral for completeness, accuracy and urgency and prioritize and schedule appointments according to that urgency. Contact insurance companies to determine requirements, benefit coverage to obtain authorization for services. Utilize and interpret detailed scheduling guidelines and a moderately complex scheduling system to schedule and re‑schedule evaluations/appointments for the appropriate discipline and/or clinic site. Monitor eligibility of recipients for government programs and provide documentation for submission of Treatment Authorization Requests (TARs). Prepare Treatment Authorization Requests for inpatient emergent/urgent medical admissions including difficult and complex accounts pertaining to the Medi-Cal State reimbursement program. Interpret State Medi-Cal program requests for additional medical information and insurance verification when discrepancies arise. Conduct Medi‑Cal eligibility investigations and consult with professional staff to ensure payment if Medi‑Cal eligibility and authorization is questionable upon admission. Prepare medical charts, inpatient accounts, out‑of‑county forms and retroactive Medi‑Cal accounts for the State Registered Nurse to review for approval/denial of Treatment Authorization Requests for reimbursement from the State Medi‑Cal program. Compile statistics on workflow and production and write concise summaries. Maintain detailed data spreadsheets. Conduct financial screening for eligibility in various computer systems and/or interview clients to establish financial eligibility. Read and interpret information for insurance eligibility to ensure that a correct payment source is identified for reimbursement. Make data entries, read and interpret computer printouts and/or information on computer screens and solve computer‑related data problems. May act as patient representative in matters other than the admitting process when appropriate during hospitalization. Act as a liaison and resource with other hospital departments, insurance companies, programs, etc. relative to the work of the department. Perform other related duties as required. Experience Requirements Demonstrated education, training and admitting experience performing a variety of specialized, complex and technical medical office clerical tasks in a medical setting which has provided an opportunity to acquire the following: Experience Note: A candidate would normally acquire the knowledge and abilities listed below by attaining two (2) years of work experience requiring initiative and independent judgment as a Health Services Representative, Medical Receptionist or the equivalent. For positions performing the complex, technical and specialized duties of the registration and/or reimbursement process, one (1) year of experience should have been performing a variety of complex, technical and specialized duties or associated technical support duties in connection with the reimbursement for services, financial screening and/or registration of clients for medical or other services. Knowledge Credit interviewing and investigation techniques. Policies and procedures related to the program, medical treatment, screening area, or specialized technical support area to which assigned. Legal requirements of State, Federal and SCVH&HS Policies and Procedures related to collection activity and the release of confidential patient information. Medical terminology. Hospital registration, reimbursement, or referral practices and procedures. Standard hospital services, organizations and outpatient clinics. Modern office administrative practices and procedures including computer skills. Principles and practices of customer service and telephone courtesy. Various funding programs and eligibility requirements, i.e., Managed Care Medi‑Cal, Medi‑Care, California Children Services (CCS), Healthy Kids, Healthy Families, Ability to Pay Program, etc. Rules and regulations as they relate to insurance claim procedures, reimbursement and authorization requirements, and referral procedures. Technical details involved in the complete registration and/or reimbursement process. Insurance claim procedures and reimbursement requirements. Policies and procedures related to medical patient services, insurance and billing for processing insurance claims and/or billing charges. Purpose and use of International Classification of Disease Standards. Purpose and use of the Concurrent Procedure Terminology. Ability Interview for the purpose of gathering adequate and precise information. Make arithmetical computations of moderate difficulty. Analyze, interpret, apply, implement and explain rules and regulations pertaining to the registration, reimbursement, or referral process. Read and interpret rules, policies, and/or procedures. Discuss difficult issues in a sensitive manner. Provide clear and concise information both verbally and in writing. Use discretion and judgment in the handling of sensitive and confidential information. Prioritize work and respond to changing and/or conflicting tasks in a dynamic work environment. Type with moderate speed and accuracy. Establish and maintain cooperative working relationships with all levels of medical, professional, administrative and support personnel contacted in the course of work. Assign, guide and review the day‑to‑day work of a clerical staff performing clerical tasks involving patient registration. Provide day‑to‑day training and evaluate the work performance of subordinates. Monitor and maintain workflow to review work for errors, production and performance. Handle all aspects of the registration process, including the difficult and complex cases. Adapt quickly to changing regulations and procedures. #J-18808-Ljbffr County of Santa Clara