Senior Health Services Representative

Description Under general supervision, the position involves providing lead supervision to a clerical staff engaged in a variety of work related to the registration and reimbursement processes for clients to a patient care area or agency program service site throughout the Santa Clara Valley Health & Hospital System. Alternatively, the role may involve performing a variety of complex, technical, and specialized assignments related to the registration and reimbursement process for clients to the same service sites. Typical Tasks Lead Supervision responsibilities: Provides lead supervision of a clerical staff engaged in registration and admission procedures. Performs routine tasks as well as more technically difficult or complicated duties associated with the duties of a Health Services Representative. Assists in training, monitoring, and guiding new employees. Assists in developing and/or revising internal procedures related to the admission process of a particular department. Counsels and assists in performance evaluation and corrective action matters of subordinate personnel. Interprets and explains new or revised registration and clerical procedures to staff, clients, and other departments. Communicates with various internal and external departments to provide/obtain accurate client information to complete the registration process. Performs related work as required. OR Processes technically difficult or complicated financial screening and insurance authorizations or referrals. Processes difficult credit, collection, or program application cases including out‑of‑county Medi‑Cal cases and Medi‑Care exhausted accounts. Reviews and evaluates referrals for completeness, accuracy, and urgency and prioritizes and schedules appointments accordingly. Contacts insurance companies to determine requirements, benefit coverage, and obtain authorization for services. Utilizes and interprets detailed scheduling guidelines and a moderately complex scheduling system to schedule and re‑schedule evaluations and appointments. Monitors eligibility of recipients for government programs and provides documentation for submission of Treatment Authorization Requests (TARs). Prepares TARs for inpatient emergent/urgent medical admissions including difficult and complex Medi‑Cal accounts. Interprets State Medi‑Cal program requests for additional medical information and insurance verification when discrepancies arise. Conducts Medi‑Cal eligibility investigations and consults with professional staff to ensure payment on questionable eligibility. Prepares medical charts, inpatient accounts, out‑of‑county forms, and retroactive Medi‑Cal accounts for review by the State Registered Nurse. Compiles statistics on workflow and production and writes concise summaries. Maintains detailed data spreadsheets. Conducts financial screening for eligibility in various computer systems and/or interviews clients to establish financial eligibility. Reads and interprets information for insurance eligibility to ensure correct payment source for reimbursement. Makes data entries, reads computer printouts, and solves computer‑related data problems. MAY act as patient representative in matters other than the admitting process during hospitalization. Acts as liaison and resource with other hospital departments, insurance companies, and programs. Performs other related duties as required. Employment Standards Experience Two (2) years of work experience as a Health Services Representative, Medical Receptionist, or equivalent, requiring initiative and independent judgment. For positions performing complex, technical, and specialized duties of the registration and/or reimbursement process, one (1) year of experience performing such duties or related technical support is required. Knowledge Credit interviewing and investigation techniques. Policies and procedures related to the program, medical treatment, screening area, or specialized technical support area to which the unit is assigned. Legal requirements of State, Federal, and SCVH&HS policies related to collection activity and 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 computer skills. Customer service and telephone courtesy principles and practices. Funding programs and eligibility requirements including Managed Care Medi‑Cal, Medi‑Care, California Children Services (CCS), Healthy Kids, Healthy Families, Ability to Pay Program, etc. Ability Interviewing for gathering adequate and precise information. Arithmetical computations of moderate difficulty. Analyzing, interpreting, applying, implementing, and explaining rules and regulations pertaining to the registration, reimbursement, or referral process. Reading and interpreting rules, policies, and procedures. Discussing difficult issues in a sensitive manner. Providing clear and concise information both verbally and in writing. Using discretion and judgment in handling sensitive and confidential information. Prioritizing work and responding to changing or conflicting tasks in a dynamic environment. Typing with moderate speed and accuracy. Establishing and maintaining cooperative working relationships with all levels of medical, professional, administrative, and support personnel. Supervisor Knowledge Supervisory techniques, principles, and practices. Principles and practices of effective communication. Group coordination techniques and principles. Supervisor Ability Assigning, guiding, and reviewing the day‑to‑day work of clerical staff performing patient registration tasks. Providing day‑to‑day training and evaluating the work performance of subordinates. Monitoring and maintaining workflow to review work for errors, production, and performance. #J-18808-Ljbffr