City and County of San Francisco

Under direction, supervises, assigns, reviews and participates in the work of a unit responsible for a variety of hospital registration, admitting and discharge functions with the objective of determining eligibility of patients for assistance under the terms of various public and private health care and financial assistance programs including Medi-Cal and Medicare to maximize hospital reimbursement and facilitate patient care; and performs a variety of technical tasks relative to assigned area of responsibility.

This is a first level supervisory class, which assumes responsibility for and participates in the work of a unit responsible for a variety of registration, admitting, and discharge functions and for the determination of eligibility for appropriate private and public payer sources for medical treatment.

Positions in this classification are responsible for explaining and enforcing regulations and procedures pertaining to public health assistance and related programs, and for exercising independent judgment in assessing and resolving patient accounts and complex reimbursement issues. Positions in the subject class differ from those in class 2908 which perform advanced journey level functions, in that the former have responsibility for supervising the maintenance of records and related statistics and submitting reports on the activities of the unit. Positions in this class communicate with patients, their relatives, hospital staff, and representatives of outside agencies and the public.

The 2909 Hospital Eligibility Worker Supervisor is distinguished from the 2907 Eligibility Worker Supervisor in that the 2909 class is responsible for supervising the determination of client eligibility for medical coverage under the terms of various private health care plans and public assistance programs including Medi-Cal and Medicare, while the 2907 class is responsible for supervising the determination of client eligibility and certification for reimbursement under the terms of various social service programs.

The 2909 Hospital Eligibility Worker Supervisor is responsible for supervising a unit of professional, technical and clerical workers performing activities with the objective of determining eligibility for assistance and enrolling patients in various public and private health care and financial assistance programs.

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. Plan, prioritize, assign, supervise and review the work of a unit responsible for providing the review and determination of eligibility of patients for medical treatment under the terms of various public and private medical and financial assistance programs including Medi-Cal, Medicare and other third party payers.

2. Participate in the selection of unit staff; provide or coordinate staff training; work with employees to correct deficiencies; implement discipline procedures as required.

3. Recommend and assist in the implementation of goals and objectives; establish schedules and methods for providing services; implement policies and procedures.

4. Evaluate operations and activities of assigned responsibilities; recommend improvements and modifications; prepare statistical summaries and reports on staff, operations and activities.

5. Assist in the preparation and monitoring of the budget.

6. Answer questions and provide information to the public; investigate complaints and recommend corrective action as necessary to resolve complaints.

7. Review and evaluate staff work in determining financial eligibility for a variety of payment sources; verify eligibility and financial assistance levels according to established policies and procedures; review completed cases with respect to eligibility factors and billing recommendations.

8. Maintain on-going effective communication with various clinical staff including radiology staff, nursing staff and physicians.

9. Review and interpret administrative letters, memos and changes in program regulations; evaluate impact of changes on internal procedures and hospital reimbursement for patient care; update staff on changes in regulations and policy or procedures; maintain providers’ eligibility and procedures manual.

10. Determine eligibility, recommend and explain third party payment source programs, qualification standards, policy and procedure to patients; assist patients in completion of applications and forms when necessary; review and evaluate Medi-Cal applications for completeness and accuracy; when necessary, prepare patient budget to determine eligibility.

11. Prepare records related to patient eligibility information and payment source received; update records; submit required reports.

12. Investigate and verify statements and information received from patient and families.

13. Act as liaison with public and private medical care plans, outside institutions and community organizations.

14. Oversee coordination of transfers of patients between various hospitals or medical facilities; ensure patients are informed of transfer procedures.

15. Oversee assignment of beds for patients being admitted; monitor bed availability; maintain a safe and clean work environment for employees.

16. May oversee workers assigned to a long term care facility; supervise the regulating of patient finances, facilities of burial arrangements, and disposition of estate.

17. Oversee the maintenance and operation of computer and manually operated data equipment; monitor adequacy of office supplies and forms; order supplies and forms as required; prepare biweekly master payroll roster.

18. Perform related duties as required.

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; methods and techniques of financial counseling; provisions of major public and private health care plans; principles and practices of caseload management; 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: Compile, interpret and explain legal information and Federal, State and local laws and regulations; 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 clearly and concisely, both orally and in writing; establish and maintain cooperative working relationships with those contacted in the course of work.

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.

Education: None

Experience:

Two (2) years of verifiable work experience in a hospital determining the eligibility for Medi-Cal, Medi-Care or other sources of hospital reimbursement. This work must have been performed within the last five (5) years and must be equivalent to the work performed by a class 2908 Senior Hospital Eligibility Worker.

License and Certification:

Must obtain Certified Enrollment Counselor Certification for Covered California and pass federal background check within 3 months of hire.

Amended: 11/12/2014

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.