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Home My WebLink AboutMINUTES - 07231985 - 1.36 1- 136 POSITION ADJUSTMENT REQUEST No. Date: 6/27/85 ers Co . Dept. No./ r p Department Health Services/CGRP Budget Unit No. 0,._860 r .x',`_6118 Agency No. 54 jot t, A �!S Action Requested: Reallocate Clerk-experienced level,pgd. 54Jj?40)t6=A.ccount Clerk - Beginning level Proposed Effective Date: 7/24T8 Explain why adjustment is needed: To properly classify the incumbent (Alma Clowes) according to duties and responsibilities Classification Questionnaire attached: Yes ® No (lateral transfe4 no change. in Estimated cost of adjustment: s salary) . Cost is .within department's budget: Yes ® No [] If not within budget, use reverse side to explain how costs are to be funded., Department must initiate necessary appropriation adjustment. Web Beadle. Use additional sheets for further explanations or comments. De artmental Personnel Officer: or Department ea Personnel Department Recommendation Date: Reallocate Clerk - Experienced Level position #54-1240, Salary Level C5 0964 f (1191-1448) to Account Clerk- Beginning Level , Salary Level C5 0964 (1191-1448). s E • 1 M J 4 ' Amend Resolution 71/17 establishing positions and resolutions allocating classes to the Basic/Exempt Salary Schedule, as described above. Effective: 5) day following Board action. Oa"\ V..aA UA Date irec t or rson e County Administrator Recommendation • �S U Date. Approve Recommendation of Director of Personnel D Disapprove Recommendation.of Director of Personnel t O Other: for County Administrator Board of Supervisors Action PhD Batchelor,perk of the Board rf Adjustment APPROVED/ on JUL 2 3 1965 pa wr Date: JUL 2 31985 rPROVAL .OF THIS ADJUSTMENT CONSTITUTES A PERSONNEL/SALARY RESOLUTION AMENDMENT. 1 ACCOUNT CLERK DEEP CLASS C L A S S I F I C A T I O N Q U E S T I 0 N N A I R PAY l 'j 1985 CC-i%IISA COSTA COUNTY ALMA CLOWES Health Services Contra Costa He0iMITlRWRRVICp�p,�ANNpf fi ce Name Department Division Work Unit 816 Main St. , Martinez Job Classification WorkLocation 3aress Intermediate Typist Clerk Percent of Description of Work: Time Required 90% Claims Processing and Accounts .Payable: I receive bills from non-Health Services Department providers for services rendered to Health Plan patients. It is my responsibility to process these bills in a timely manner, which requires several complex steps. I determine the type of Health Plan coverage the patient had on the date, the service was performed. This requires knowledge of all Health Plan groups, their benefit packages, and other sources of payment (such as Medi- care and Crippled Children's Services) . I verify whether an authorization for payment was issued. If an authorization was issued, it is my responsi- bility to review the patient's utilization history to ensure that the maximum number of visits has not been exceeded. I review the provider's payment history to eliminate duplicate payments. I inspect each bill for medical accuracy, which requires knowledge of diagnosis codes, procedure codes, modifiers, and.medical terminology. I must be sure that the diagnosis matches the medical report, laboratory tests, radiology and central supplies. Before a bill is sent to the Auditor-Controller for payment, I must decide j which cost center, expense code, task code and option code to use for payment and code each bill accordingly. This determination is made by re- viewing that date of service, type of service, number of units, and type of coverage. This is a highly responsible function which requires extreme j accuracy to properly calculate incurred liability on the Health Plan expenditure ledger. I calculate the amount of payment based on the type of coverage the patient had. Adjustments are then made according to the patient's Explanation of Medicare Benefits, the provider's private charges, or the Schedule of Allow- ances which is a constantly changing schedule set up by the State of Cali- j fornia. This is also a highly responsible function requiring extreme accuracy because I must remain within the boundaries of Medicare and Medi-Cal regulation while reducing Health Plan expenditures. After each claim has been adjusted, -1 approve it for payment with a stamp and my initials. This is an extremely large responsibility since these expenditures totaled over $2 million last fiscal year. 10% I am responsible for assigning new vendor numbers for non-Health Plan providers and maintaining and updating the vendor file. I inform the Auditor-Controller's Office of the new vendors and changes to the file. It is essential that I record the proper vendor number on each bill to ensure that payment is made to the proper provider at the correct address. The final task I perform in my Claims Processing function is entering each claim in the Health Plan computer system. . Each claim must be individually entered using diagnosis codes, general ledger codes, and procedure codes. This task requires knowledge of Medi-Cal and Medicare codes, as well as an extensive knowledge of our computer system. Human Interaction: If there is a problem on a claim, such as incomplete documentation on Medicare patients, lack of proper forms, no medical report, invalid procedure codes or diagnosis codes, I type a letter to the provider, of service requesting the proper information. This can sometimes 'be con- fusing since some providers are contracted 0th billing services., and I must work through the service to get any additional information required to process their claim in a timely manner. ACCOUNT CLERK CLASSIFICATION QUESTIONNAIRE (Continued) Percent Of Description of Work: Time Required I receive phone calls from outside providers, the Auditor-Controller's Office, Health Plan members, Health Care Representatives, clinic sites and authorization units regarding billing procedures, payment schedules and the status of claims. I- must be able to answer these inquiries as quickly as possible while projecting a professional image and staying within the boundaries of Medicare, Medi-Cal and Health Plan regulations. Sometimes I get phone calls from irate patients or providers who are frustrated because they do not under- stand how their bill is being handled. It is my responsibility to explain the Health Plan's policies and procedures while assuring the caller that their claim is being processed in the most efficient manner possible. For example, one of the Health- Plan members received bills for outside services and was finally assigded to a collection agency. I wasn't aware that the patient had been assigned to collec- tion. In researching the problem, I found that the service for the outside hospital visit had been authorized and the bill had been paid, but the bills from the physicians had never been received in our office. I obtained authorization for the physicians' services from the authorization unit. I then called the provider hospital billing department, giving them the warrant number and date of payment. Next I telephoned the physicians' billing service, assuring them the Health Plan would pay the patient's bills and to have the bills recalled from collection. Summary: I perform many complex and specialized clerical tasks with a high level of responsibility. I use my own discretion in problem solving unless it is a unique or unusual problem or a Health Plan policy needs to be clarified for a specific situation, in which case I refer it to BusinessOfficeSupervisor/s. ALMA CLOWES EMPLOYEE NAME 1 . What is the function of your work unit? Processing claims from non-Health Services Department providers for payment through the Auditor-Controller's Office. 2. For whom or for what group are you providing accounting clerical support? Health Plan members, outside providers, the Audito-Controller's Office, Health Care Representatives, clinic sites, authorization units, Health Plan Fiscal Officer, , Health Plan Business Office. 3. Designate the name and title of the person who supervises' your position. How is your work reviewed? -Maria Davis -- Supervisor, Business Services Ginger Marieiro -- Supervisor, Business Services Auditor-Controller's Office reviews claims only for discrepancies; -unique or unusual problems are referred to Business Office Supervisor/s. 4. Where is your supervisor located in proximity to your desk? Our office is divided into separate offices and the Business OfficelSupervisors are located two doors away. 5. What are the most important assignments you perform and why? Processing out-of-plan claims for payment and problem solving. These functions require extensive knowledge of Medi-Cal and Medicare regulations, medical terminology and Health Plan policies and procedures. 6. What is the most difficult or complex work you perform and why? Processing out-of-plan claims for payment. This is difficult because of the need for knowledge of Medi-Cal CSC rates and regulations, and Medicare benefit' packages. 7. What parts of your job involve the greatest responsibility and why? Processing out-of-plan claims for payment. I have a responsibility to the patient and professionals of the medical field to pay bills in a timely manner which is compatible with stated and implied Federal , State and Health Plan policies. B. List the name and job titles of employees to whom you are assigned to provide lead direction. N/A 9. Do you deal with extraordinarily difficult, angry or potentially explosive persons? Provide an example and indicate the frequency of these contacts and what your respons- ibility is in these situations. I deal with patients who are upset by receiving bills from outside providers. It is my responsibility to assure them that their claim is being handled in the most efficient manner possible. 10. How long have you been in your current position? 6 (Y_e_a_r_s)_ (Months) 11 . Where were you assigned before this position? Desk, Department, Location, Assignment. Health Plan Computer, 816 Main St,. , Martinez. I provided clerical , I/O control , CRT troubleshooting, accounts payable for computer orders, contracts for maintenance and software support, contact for computer vendors. (Signature) (Date} COMMENTS OF IMMEDIATE SUPERVISOR Do you concur or disagree with the statements of the employee? . If you disagree, be specific as to why. CA �SY� What parts of this job do you check or review closely and why? QAC NAA. - 5 47_ 6�- Y' c GC4Cc ��o��`L�/ CG!ft'�J L' cC .Z` cl•G� .c.�l„�ri� L�'Y<L�L�fd' !!mac/U !L�/c,u [�.c�.1,'a��Tc�-��j�Ld GcL�iri"si <� (Signature) = J' .� .o �,� �'�2��, (Date) COMMENTS OF DEPARTMENT HEAD / DESIGNEE Comment on the statements of the employee and supervisor. If you disagree with the employee and/or supervisor, be specific. 4&A S ACC,",41, 4 .44 Me EA j 7UAO A0 44 c (Signature) (Date) 4, v