PATIENT RESOURCES WORKER

Patient Resources Worker

We are pursuing qualified candidates to fill the Patient Resources Worker position within the Department of Public Health. This position 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.

What will I do as a Patient Resources Worker?

• 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 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 health care services, 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 facility staff member.
• Initiates and/or processes applications for a variety of reduced no-cost/low cost programs, such as ATP and UMDAP. Patient Access
• Greets and registers patients in person or over the phone. Obtains demographics, preferred pharmacy, emergency contact and insurance information. Enrolls patient using electronic system. Provides forms to patients and completes paperwork for requested services. Determines when language interpretation is needed. Orients patients to health services by providing direction to appropriate locations for services.
• Initiates and/or processes applications for a variety of reduced no-cost/low-cost programs, such as ATP and UMDAP.
• Verifies coverage and empanelment prior to scheduling. Identifies when authorization and/or letter of agreement may be needed. Identifies discrepancies in assignment and empanelment and appropriately refers complex cases to Patient Relations Representatives.
• Schedules patient visits by determining the appropriate providers and programs for patients. Ensures timely access to services by actively monitoring and coordinating multiple provider schedules and maintaining appointment templates for clinic providers.
• Re-verifies eligibility in the month of the appointment to financially clear patients for appointments, conducts patient outreach by phone and/or mail, explains coverage options, refers the patient to member services as needed, and cancels appointments. Checks-in patient for appointment to explain payment options, obtains signatures, collects fees, and keeps records of insurance and patient identification.
• Performs other related duties, as necessary.

Requirements to qualify:

• Option I: Two (2) 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.
• Option II: Three (3) years of clerical experience, two (2) 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.
• Option III: Two (2) years of experience involving public contact in the investigation and collection of accounts receivable.
• Option IV: Completion of sixty (60) semester units or ninety (90) quarter units *.
• Option V: Two (2) years of experience in a health care setting with responsibility for performing patient access related work in the Emergency Department, Urgent Care or other walk-in registration, admitting, financial screening and eligibility verification, and scheduling area.
• License: A valid California Class C Driver License or the ability to use an alternative method of transportation when needed to carry out job-related essential functions.

Desirable qualification:

• Customer service experience working with the public.