PATIENT RESOURCES WORKER

Position/Program Information

EXAM NUMBER

b9192J

TYPE OF RECRUITMENT

OPEN COMPETITIVE

FILING START DATE

July 3 , 2024 at 8:00 a.m. (PT)

This examination will remain open until the needs of the service are met and is subject to closure without prior notice.

NO OUT-OF-CLASS EXPERIENCE WILL BE ACCEPTED. REQUIRED EXPERIENCE MUSTBE FULLY MET AND INDICATED ON THE APPLICATION BY THE LAST DAY OF FILING.
DEFINITION:
Identifies patients' financial resources to pay for medical and/or mental health care and services; andassists patients in making assignments for medical benefits, and completes standardized billing forms based upon data acquired.

CLASSIFICATION STANDARDS:
Positions allocable to this class typically report to a Supervising Patient Financial Services Worker I. Positions in this class obtain required demographic and insurance information and identify third-party resources by interviewing patients or their relatives and/or representatives in person or by phone to determine patient's financial resources to pay for health care services. In addition to identifying financial resources, some positions may be assigned to identify a patient’s primary care provider, Independent Physician Association/Participating Physician Group (IPA/PPG) and appropriate network for services; schedule and register patients, resolve associated discrepancies, and handle routine customer service inquiries and problems in the patient access units or Business Office units. Incumbents assigned to function as patient access representatives may report to a Patient Relations Representative for technical oversight and to a Supervising Patient Financial Services Worker I for full administrative supervision.

Positions in this class assist patients to determine their potential eligibility to enroll in health care programs, including potential eligibility for managed care enrollment. Positions obtain patient signatures on benefit assignment forms to assign and authorize payment of insurance benefits directly to the County, and process applications for a variety of no-cost/low-cost health care programs, such as Ability To Pay (ATP), Uniform Method of Determining Ability to Pay (UMDAP), Ryan White/Casewatch, Family Planning Access Care Treatment and Hospital Presumptive Eligibility.

Incumbents assigned to patient access work in accordance with all applicable Office of Patient Access policies, procedures, and guidelines and require understanding of the different health insurance coverage types and managed care rules and contracts to determine a patient’s options for accessing services. Positions require basic knowledge of patient scheduling and registration workflows and procedures.

Patient Resources Workers are distinguished from Patient Financial Services Workers (PFSW) in that Patient Resources Workers screen and refer patients with Medi-Cal linkage to PFSWs for further eligibility determination and screening; and from incumbents of the Intermediate Clerk and the Intermediate Typist-Clerk classes who may direct the patient, relative, and/or authorized representative for financial screening.

Essential Job Functions

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

SELECTION REQUIREMENTS:

Option I: Two 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 years of clerical experience, two 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.

LICENSE:
A valid California Class C Driver License or the ability to utilize an alternative method of transportation when needed to carry out job-related essential functions.

PHYSICAL CLASS: II-Light:
This class includes administrative and clerical positions requiring light physical effort, including occasional light lifting to a 10 pound limit and some bending, stooping, or squatting. Considerable ambulation may be involved.

DESIRABLE QUALIFICATION:
Additional credit will be given for experience related to the desirable qualification.

• Experience identifying discrepancies and ensuring accuracy in service billing processes related to Medicare, Medi-Cal eligibility, or private insurance.
• Experience conducting health care eligibility verifications via real-time, website, automated telephone or Point of Service (POS) devices, particularly Medicare, Medi-Cal eligibility, or private insurance checks using the State Medi-Cal website, the Automated Eligibility Verification System (AEVS)*, or a Point of Service (POS) device** and interpreting eligibility responses.
• Experience conducting detailed financial reviews of clients’ eligibility services or benefit to assess compliance and ensuring adherence to regulatory guidelines and policies for clients’ eligibility criteria.

Additional Information

SPECIAL INFORMATION
*Automated Eligibility Verification System (AEVS) is an interactive voice response system that allows providers the ability to access Medi-Cal subscriber eligibility information through a touch-tone telephone.

**Point of Service (POS) device is used to verify recipient eligibility, clear Share of Cost liability, reserve Medi-Services, perform Family PACT (Planning, Access, Care and Treatment) client eligibility transactions and submit pharmacy or CMS-1500 claims.

Past and present mental health clients and their family members who meet the selection requirements are encouraged to apply.

AVAILABLE SHIFT:

Any - Appointees may be willing to work any shift, including evenings, nights, weekends and holidays.

EXAMINATION CONTENT
This examination will consist of an evaluation of experience and desirable qualification based on information listed on the online application and supplemental questionnaire at the time of filing, weighted 100%. Additional credit will be given for experience related to the desirable qualification.

Applicants must achieve a passing score of 70% or higher in order to be placed on the eligible register.
VACANCY INFORMATION
The eligible register for this examination will be used to fill vacancies in the Department of Mental Health.

ELIGIBILITY INFORMATION
The names of applicants receiving a passing grade in the examination will be placed on the eligible register in the order of their score group for a period of twelve (12) months following the date of promulgation.

RETAKE: NO PERSON MAY COMPETE FOR THIS EXAMINATION MORE THAN ONCE IN A TWO TWELVE (12) MONTH PERIOD.

Applications will be processed on an “as-received” basis and those receiving a passing score will be promulgated to the eligible register accordingly.

APPLICATION AND FILING INFORMATION
Applicants are required to complete and submit an online Los Angeles County Employment Application AND Supplemental Questionnaire in order to be considered for this examination. Paper applications, resumes, or any unsolicited documents will not be accepted in lieu of completing the online application and Supplemental Questionnaire.

Applicants must submit their applications by 5:00 pm, PST, on the last day of filing.
INSTRUCTIONS FOR FILING ONLINE
Apply online by clicking on the green "Apply" button at the top right of this posting. You can also track the status of your application using this website. Clear and legible copies of the required documents (e.g. Diploma, Official Transcripts, License) must be uploaded as attachments during application submission --or -- by email to exams@dmh.lacounty.gov within seven (7) calendar days from date of application submission. Indicate the Exam Title on the subject line when sending required documents by email.

The acceptance of your application will depend on whether you have clearly shown that you meet the Selection Requirements. Your online application must show complete license, education and work experience information necessary to evaluate your qualifications. License information section must show title of license, license number, original date of issue, and expiration date. Education information section must include name and address of school attended, complete dates attended, name of course/s taken, number of units earned, and degree/s earned. Work experience section must include job title, employer name and address, name of work area/facility, actual payroll title held and not the working and/or functional titles, from/to dates of employment including month, day and year, total number of months, total number of hours worked per week - not a range of hours (full or part-time), and complete and detailed description of related job duties. If range of hours is provided, experience will be prorated based on the lowest number of hours worked per week. LIST separately each job experience to be evaluated.

All information is subject to verification. Applicants may be rejected at any stage of the selection process.

IMPORTANT NOTES:

• All information is subject to verification. Applications may be rejected at any stage of the selection process.
• Falsification of any information may result in DISQUALIFICATION OR RESCISSION OF APPOINTMENT.
• Utilizing VERBIAGE from class specifications and Selection Requirement serving as your description of duties WILL NOT be sufficient to demonstrate that you meet requirements. Doing so may result in an INCOMPLETE APPLICATION and you may be DISQUALIFIED.

CORRESPONDENCE AND UPDATES WILL BE SENT VIA E-MAIL

For the time being, all notifications, including results letters and notices of nonacceptance, will be sent electronically to the email address provided on the application. It is important that you provide a valid email address. Please add exams@dmh.lacounty.gov, isan@dmh.lacounty.gov, and info@governmentjobs.com to your email address and list of approved senders to prevent email notifications from being filtered as spam/junk/clutter mail.

Applicants have the ability to opt out of emails from LA County. If you unsubscribe, you will not receive any email notification for any examination for which you apply with Los Angeles County. Regardless of whether you choose to unsubscribe, you can always check for notifications by logging into governmentjobs.com and viewing your profile inbox, which saves a copy of all emailed notices.

SOCIAL SECURITY NUMBER
Please include your Social Security Number for record control purposes. Federal law requires that all employed persons have a Social Security Number.

COMPUTER AND INTERNET ACCESS AT LIBRARIES
For applicants who may not have regular access to a computer or the internet, applications can be completed on computers at public libraries throughout Los Angeles County.

NO SHARING USER ID AND PASSWORD
All applicants must file their applications online using their own user ID and password. Using a family member or friend's user ID and password may erase a candidate's original application record.

FAIR CHANCE INITIATIVE:

The County of Los Angeles is a Fair Chance employer. Except for a very limited number of positions, you will not be asked to provide information about a conviction history unless you receive a contingent offer of employment. The County will make an individualized assessment of whether your conviction history has a direct or adverse relationship with the specific duties of the job, and consider potential mitigating factors, including, but not limited to, evidence and extent of rehabilitation, recency of the offense(s), and age at the time of the offense(s). If asked to provide information about a conviction history, any convictions or court records which are exempted by a valid court order do not have to be disclosed.
DEPARTMENT CONTACT
HR Examinations Unit: (213) 972-7034

HR Examinations Unit Email: exams@dmh.lacounty.gov

Analyst Contact Phone: Irene San, 323-705-4074

Analyst Contact Email: isan@dmh.lacounty.gov

ADA Coordinator Phone: (323) 705-4074
Teletype Phone: (800) 735 - 2922
California Relay Services Phone: (800) 735 - 2922

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