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Department of Human Resources

Hospital Eligibility Worker (#2908)
$30.30-$36.83 Hourly / $5,252.00-$6,383.00 Monthly / $63,024.00-$76,596.00 Yearly




Definition
Under general supervision, performs a variety of hospital registration, admitting and discharge functions with the objective of determining eligibility for medical coverage under the terms of various private and public health care and financial assistance programs including Medi-Cal and Medicare to maximize hospital reimbursement and facilitate patient care.

Distinguishing Features
Positions in this classification are responsible for carrying out and explaining the provisions of various health care programs as well as the policies and procedures of the hospital as they pertain to a variety of registration, admitting, and discharge functions and for the determination of eligibility for appropriate payor sources for medical treatment. Positions in this class have regular contacts with patients, their relatives, hospital staff, and representatives of outside agencies and the public. The 2908 Hospital Eligibility Worker is distinguished from the 2903 Eligibility Worker by the performance of the full range of duties as assigned. Employees at this level receive only occasional instruction or assistance as new or unusual situations arise, and are fully aware of the operating procedures and policies of the work unit. The 2908 Hospital Eligibility Worker is distinguished from the 2905 Senior Eligibility Worker in that class 2908 identifies and determines client eligibility for medical coverage under the terms of various private health plans and public assistance programs, whereas class 2905 determines client eligibility for public assistance programs and certifies for reimbursement.

Examples of Important and Essential Duties

“The class specification shall be descriptive of the class and shall not be considered as a restriction on the assignment of duties not specifically listed.” (CSC Rule 7)

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

2. Conduct interviews with patients, their relatives and others in order to identify and determine patient eligibility for coverage of medical care under various Federal or State programs or under the provisions of private, fraternal, union or other health care plans; verify hospitalization insurance and arrange for billing of the appropriate agency or health care plan; continually reviews patient’s case files to update vital statistics.

3. Obtain medical information pertaining to patients eligibility status from hospital staff; attend ward rounds with appropriate staff.

4. Determine patient eligibility for a third party payment source according to established policies and procedures including private health insurance plans, victims of crime, workers’ compensation, and lawsuit settlements.

5. Participate in generating revenue for the hospital.

6. Initiate and obtain approval of extension of Medi-Cal coverage for emergency and elective admissions.

7. Prepare records related to patient eligibility information and health care payment received; update records; submit required reports.

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

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

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

11. Coordinate transfers of patients between various hospitals or medical facilities; inform patients of procedures and necessary reports.

12. When assigned to a long term care facility, may regulate patient finances by paying bills to maintain patient eligibility and entitlement to various benefits; may facilitate burial arrangements and final disposition of estate.

13. Refer non-payment cases to appropriate authority for legal action.

14. Answer questions and provide information to patient and the general public regarding assigned program area.

15. Assist in registering patients into the hospital; provide assistance to patients in completing applications; make referrals to Social Service agencies.

 

16. Perform related duties as required.


Knowledge, Skills and Abilities

Knowledge of: Procedures, methods and techniques of assessing and screening for eligibility for reimbursement from Medi-Cal, Medicare,and other public and private medical/financial assistance programs; procedures and policies of patient registration and admitting; provisions of major public and private health care plans; departmental programs, policies, procedures and terminology; medical terminology; principles and procedures of record keeping; interviewing and investigative skills and techniques; office procedures, methods and computer equipment; basic mathematics;

Ability to: Interview applicants to obtain appropriate information and to determine eligibility for reimbursement from third party payment source, often in different languages or dialects of English; accurately gather, record and evaluate data necessary for the determination of eligibility; evaluate data and provide recommendations on patient eligibility; interpret and apply Federal, State, local, hospital and Departmental policies, procedures, laws and regulations; work independently with minimal supervision; maintain accurate records and meet program deadlines; operate a computer terminal and standard office machines; make accurate mathematical computations; plan, organize and prioritize workload; type and enter data at a speed necessary for successful job performance; exercise sensitivity to the needs of the indigent sick; establish effective working relationships with representatives of public and private health care services; effectively communicate with and elicit information from patients and collaterals in difficult situations; communicate clearlv and concisely, both orally and in writing; establish and maintain cooperative working relationships with those contacted in the course of work.


Disaster Service Workers
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.


CLASS: 2908 EST: REV: FORMERLY JOB TITLE: REPLACES JOB TITLE:
EEOC: 3 MEDICAL: