DUTY STATEMENT - CalCareers



DUTY STATEMENTCALIFORNIA DEPARTMENT OF VETERANS AFFAIRSPosition No: 576-134-5157-001Date:Class: Staff Services Analyst (General)Name:Under the direction of the the Staff Services Manager (I) at the Veterans Home of California – West Los Angeles, the Staff Services Analyst (SSA) will be responsible for a variety of technical and analytical assignments as they relate to Finance and Reimbursements for the Residential Care Facility for the Elderly (RCFE). The incumbent may utilize a variety of analytical techniques to conduct and/or review analytical studies and surveys, formulate procedures, policies, and program alternatives, and present ideas and information effectively, both orally and in writing. The SSA will consult and advise residents, administrators, managerial staff, and Headquarters staff on a wide varity of subject-matter areas as they relate to a residents financial and insurance status. Additionally, the SSA will be tasked with identifying and participating in process and quality improvement inititatives that enhance customer experiences and increase workflow efficiencies, as well as generate revenue. Duties include but are not limited to the following: Support open enrollment campaigns to encourage healthcare plan participation for eligible residents by holding enrollment fairs and attending resident town hall meetings; Continuously monitor insurance coverage of RCFE residents to avoid lapses in coverage; Complete applications for benefits on behalf of the residents.Percentage of time performing duties:ESSENTIAL FUNCTIONS40%35%Conduct financial interviews with new and current RCFE residents. Compile income information and assess monthly fee charges. Conduct income verification investigations, identify, and locate of assets. Analyze data from the Social Security Administration to confirm resident income. Obtain signatures from the resident or designated agent for all Letters of Understanding concerning assessment and payment of fees, medical insurance, necessary releases, consents and assignment of benefit forms. Maintain documentation concerning the establishment and payment of fees, payment of Aid and Attendance, and reporting of fees owed by deceased and discharged members. Compile and analyze related data to generate statistical reports and identify trends. Perform duties as program analyst to support medical billing and maximize reimbursements. Assist in developing or modifying business processes, procedures, and functional requirements. Analyze, interpret, and apply rules and regulations from various governing agencies such as the CA Department of Social Services (DSS) the Veterans Administration (VA) and Centers for Medicare and Medicaid (CMS). Research program processes, analyze for revenue sources and implement procedures to bill new sources of revenue. Consult with Veterans Service Officers on resident enrollment and eligibility of VA benefits.Verify eligibility and benefits for Medicare, Medi-Cal, and other health insurances. Assist with administration of health insurance programs including development and analysis, establishment and tracking of related correspondence, and reporting data related to Medicare, Medi-Cal, and other health insurance coverage. Maintain and track reporting of Medi-Cal redetermination and verify eligibility, benefits, and appropriate treatment authorizations requests are obtained. Work with government and private agencies on establishing eligibility, benefits, and authorization of medical services. Knowledge of Agency Charge Master including current procedural and diagnosis codes. Process prior authorizations and letters of agreement for securing reimbursements.20%Perform all month-end checklist verifications. Take over the collection of delinquent fees after initial notice is sent to resident. Provide prompt counseling to residents on delinquent member account statements. For continued non-payment, issue legal notices, provide recommendations to the Administrator on options for payment plans and work with the Legal Office to start discharge proceedings. Perform higher level income verification investigations using data from the Social Security Administation, Franchise Tax Board and other sources. Confer with the Calvet Headquarters Estates Officer with regard to settlements and disposition of collected assets. Provide testimony and information in the event of litigation that involves enforcing applicable statutes. Conduct all Aspects of estate settlement including pre-need consultation with resident and families for burial preferences. Analyze the reimbursements received and expenditures made on behalf of residents and provide unreimbursed cost of care statements to residents as required by law. Perform all steps in the Conveyance of Funds checklist and partner with the Legal Office to determine estate of deceased residents. Attend meetings, conferences and/or trainings as they relate to the analysis, development and redesign of the operations and automated systems for all insurance billing processes. Percentage of time performing duties:NON-ESSENTIAL FUNCTIONS5%Other related duties as assigned.Position No: 576-134-5157-001Date:Class: Staff Services Analyst (General)Name:PART B - PHYSICAL AND MENTAL REQUIREMENTS OF ESSENTIAL FUNCTIONSActivityNot RequiredLess than 25%25%to 49%50%to 74%75% or MoreVISION: Observe residents and staff; View computer screen; prepare various forms, memos, reports, letters, and proofread documents.XHEARING: Answer telephone; communicate with Administration, department managers, department staff, residents, family members and visitors.XSPEAKING: Communicate instructions and information to staff, residents and the public in-person and via telephone; interact in meetings.XWALKING: Transport information and materials within administration building; attend mandatory meetings and trainings in alternate building locations.XSITTING: Work station; meetings; training.XSTANDING: Copy documents; review records.XBALANCING: As needed to perform duties.XCONCENTRATING: Review documentation for accuracy; complete forms; monitor area for safety; calculate fees; maintain alertness during meetings and trainings; research laws, rules and processes.XCOMPREHENSION: Understand and promote the mission, core values, vision, goals and objectives of CDVA; the needs of residents, staff, family members and visitors; policies and procedures, regulations and laws; content of meetings, trainings and work discussions; facilitate the dynamic of team work.XWORKING INDEPENDENTLY: Must be able to calculate and apply patient benefits/insurance eligibility and coverage with minimal guidance.XLIFTING UP TO 10 LBS:XLIFTING 10- 25 LBS:XLIFTING 25-50 LBS:XFINGERING: Push telephone buttons, calculator keys and computer keyboard; manipulate writing utensils; sort through paperworkXREACHING: Answer telephone, use a mouse; print documents on desk printer; store and access deceased or discharged resident property.XCARRYING: Transport documents, mail and small objects.XCLIMBING: As needed to perform duties.XBENDING AT WAIST: Use copier; interact with residents in wheelchairs; access low file drawers.XKNEELING: As needed to perform duties.XPUSHING OR PULLING: Open and close file drawers; push cart.XHANDLING: Sort paperwork; distribute mail.XDRIVING: As needed to perform duties and attend training; special events.XOPERATING EQUIPMENT: Computer, telephone, copier, printer, fax machine, various medical equipment.XWORKING INDOORS: Enclosed office environment.XWORKING OUTDOORS: Special events.XWORKING IN CONFINED SPACE: File, supply, storage rooms, etc.XI have read and understand the duties listed on this Duty Statement and I can perform these duties with or without reasonable accommodation. (If reasonable accommodation may be necessary, discuss any concerns with the Equal Employment Opportunity Office.)Employee signature Date Supervisor signature Date Human Resources signature Date Revised 5/17/2017 ................
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