Series established July 26, 1972
This series specification describes four Patient Benefit and Insurance classes in the California state service which perform patient affairs management services.
Patient Benefit and Insurance Officers work in the Department of Developmental Services headquarters or regional offices of the Patient Benefit and Accounts Branch or in Developmental Services and Mental Health State hospitals and the Veteran's Home. Incumbents at all levels are concerned with meeting the legal obligations of the Departments to: locate, protect, and conserve patient assets; discover and obtain insurance and other benefits for patients; review guardianship inventories, appraisement, and accounting to insure the protection of patient interests; implement departmental policy to encourage the expansion of insurance and other resources to meet the costs of psychiatric treatment; maintain fiscal responsibility and accountability for Medicare and Medi-Cal Programs as they relate to the State Mental Health Program; establish uniform fees for mental health services and collection policies and procedures for the Department of Developmental Services and Community Mental Health Programs; and establish, adjust, compromise, or cancel charges for patient care and collect revenue due the State for patient treatment.
Level of difficulty, variety, and complexity of assigned duties; independence of action and decision; and supervision received and degree of supervision exercised serve as differentiating factors between classes.
This is the journeyperson level for this series. Under direct supervision, incumbents work with a patient caseload in either a hospital, regional office, or headquarters. Duties include: investigating the financial status of patients and responsible relatives; locating, protecting, and conserving assets of patients; locating and obtaining benefits and other resources on behalf of patients; and establishing, adjusting, compromising, cancelling, or collecting charges for patient treatment.
This is the advanced journeyperson level in this series. In headquarters, incumbents have regional or functional responsibility for a major portion of a statewide program.
This is the first supervisory level in this series. In a hospital, regional office, or headquarters, incumbents supervise employees responsible for a patient caseload.
This is the Program Manager level. Incumbents are responsible for a significant statewide program or may supervise a group of employees in the next lower classes.
One year of responsible administrative experience in the California state service performing duties that include locating, protecting, and managing patients' assets; investigating financial status of patients and responsible relatives; determining charges; and filing claims for benefits on behalf of patients.
Two years of full-time experience as a trust officer or assistant trust officer for a bank or savings and loan association, or as a credit manager or assistant credit manager for a finance company, bank loan department, credit association, business concern, or credit union.
(Education in a college level Business Administration curriculum may be substituted for up to one year of the required experience on the basis of one year of education being equivalent to six months of qualifying experience. The equivalent of six semester units of this education must be in accounting and three semester units must be in business law.)
Three years of full-time responsible managerial experience with primary responsibility in the extension and adjustment of credit; collection of accounts and notes receivable, with an active volume of at least l,000 accounts.
One year of experience performing the duties of a Patient Benefit and Insurance Officer I in the California state service.
Two years of experience in the California state service performing the duties of a Patient Benefit and Insurance Officer I.
One year of experience in the California state service performing the duties of a Patient Benefit and Insurance Officer II (Supervisor) or (Specialist).
One year of experience in the California state service performing duties involving the analysis and application of complex Federal and State laws, rules, and regulations pertaining to State administered insurance programs or performing work in reimbursement, revenue, or tax compliance programs. This experience must be in a class at a level of responsibility of not less than that of a Patient Benefit and Insurance Officer II (Supervisor) or (Specialist).
Education equivalent to graduation from high school.
Knowledge of: Credit and adjustment principles and procedures; investigation and interviewing techniques; legal procedure required to enforce payment of accounts; principles of property management, accounting, financial record keeping, and commercial law; laws governing probate, divorce, annulment, community property, homestead, liens, and conveyance of real property; Health and Welfare Programs, guardianships, trusts, veterans benefits, unemployment and disability insurance, fraternal order insurance programs, disability income programs, comprehensive liability insurance and automobile medical reimbursement insurances, Federal Old Age and Survivors' Insurance, workers' compensation, hospitalization insurance, retirement plans, prepaid medical care plans, health and life insurance contracts, Medicare and Medi-Cal insurance, and veterans care benefits, provisions of the Welfare and Institutions Code relating to patients' benefits and insurance; and basic medical terminology.
Ability to: Read and write English at a level required for successful job performance; apply to specific situations the provisions of the Welfare and Institutions Code relating to patients' benefits and insurance; understand and interpret legal and other documents; conduct informal conferences; negotiate equitable programs for payment of charges and settlement of claims; locate assets, ascertain sources of income, appraise the financial condition of debtors, and make practical appraisals of real property; give advice and information to interested persons and agencies and develop and maintain friendly and cooperative relations; analyze situations accurately and adopt effective courses of action; handle extensive correspondence and prepare clear and comprehensive reports; and communicate effectively.
Knowledge of: All of the above, and functions and responsibilities of the Patient Benefit and Accounts Branch; procedures followed in administrative hearings and in the lower courts; provisions of the Insurance Code, California Unemployment Insurance Code, Labor Code, Probate Code, Civil Code, and Code of Civil Procedure relating to functions of the Patient Benefit and Accounts Branch.
Ability to: All of the above, and evaluate investigation reports and case records; invoke waiver of premium provision in life and health insurance contracts on behalf of entitled patients; prepare cases for legal action; conduct conferences on complex and controversial matters; interpret the provisions of disability, auto, comprehensive, liability, indemnity, and industrial insurance policies; and determine liability for claims; determine legal costs, and prosecute for payment.
Knowledge of: All of the above, and principles of effective training and supervision; a manager�s/supervisor�s responsibility for promoting equal opportunity in hiring and employee development and promotion, and for maintaining a work environment that is free of discrimination and harassment.
Ability to: All of the above, and plan and direct the work of others; and effectively promote equal opportunity in employment and maintain a work environment that is free of discrimination and harassment.
Knowledge of: All of the above, and services and benefits available to Medicare and Medi-Cal beneficiaries from private resources and agencies; public and private agencies involved in the total Medicare and Medi-Cal Programs; rules and regulations and administrative procedures by which such programs are administered; and a manager�s/supervisor�s responsibility for promoting equal opportunity in hiring and employee development and promotion, and for maintaining a work environment that is free of discrimination and harassment.
Ability to: All of the above, and interpret and apply to specific cases the provisions of the Probate Code, Civil Code, and Code of Civil Procedure relating to patients' benefits and insurance; direct training programs and the work of a technical staff; analyze and evaluate difficult and technical laws, rules, and regulations in the health benefit fields; formulate and implement programs and procedures for improving the reporting and claims procedures for Medicare benefits; plan, organize, and coordinate the work of others and train them in new procedures; work independently in identifying the need for the development of proposed procedures and changes in operating practices and policies; and promote equal opportunity in employment and maintain a work environment that is free of discrimination and harassment.
Willingness to work irregular hours and in various locations throughout the State; willingness to travel throughout the State; tact; and neat personal appearance.