Occ. Code 6662201

 

                                                       

 

RESOURCES AND REIMBURSEMENT AGENT 1, GRADE 18

6662201

RESOURCES AND REIMBURSEMENT AGENT 2, GRADE 20

6662202

RESOURCES AND REIMBURSEMENT AGENT 3, GRADE 23

6662203

RESOURCES AND REIMBURSEMENT AGENT 4, GRADE 27

6662204

 

New York State Department of Civil Service

 

Classification Standard

 

BRIEF DESCRIPTION OF CLASS SERIES

 

Positions in this title series conduct financial investigations, determine payment sources, and develop and submit claims for the cost of care of individuals receiving care and/or treatment in State facilities and programs.  Incumbents analyze and evaluate the financial resources of individuals receiving services and financially liable relatives; develop and/or determine benefit eligibility; provide technical assistance and training to individuals, families, advocates, not-for-profits, and fiduciaries on managing individuals finances; liaison with providers and local social services districts to explain programs, policies and procedures and their impact; and take measures necessary to ensure that the personal assets of individuals receiving services are protected, developed and properly administered. 

 

These positions are classified in the Office of Mental Health (OMH), Office of Mental Retardation and Developmental Disabilities (OMRDD), Office of Children and Family Services (OCFS), and the Office of Alcoholism and Substance Abuse Services (OASAS). 

 

DISTINGUISHING CHARACTERISTICS

 

RESOURCES AND REIMBURSEMENT AGENT 1:  professional entry level; responsible for intake interviews with individuals receiving services and/or family members to determine financial resources and obtain needed documents to establish eligibility for benefits; determine rate or amount of charges; maintain billing accounts; develop benefits and entitlements; protect individuals resources; and conduct financial reviews/audits to determine third party coverage.

 

RESOURCES AND REIMBURSEMENT AGENT 2:  advanced performance level/first supervisory level; assist in management of a field or facility based reimbursement office including its computer revenue systems; provide training to new agents; handle a larger and more complex caseload; and/or supervise clerical staff.

 

RESOURCES AND REIMBURSEMENT AGENT 3:  supervisory level; in charge of field or facility based reimbursement office revenue operations and its revenue collection processes; and serve as primary liaison and support to facilities, network service providers, and outside agencies.

 

RESOURCES AND REIMBURSEMENT AGENT 4:  managerial level; assigned to manage administrative or systems units dealing with revenue in Central Office, or to manage a district and its field offices; and has major programmatic, administrative, policy and/or systems responsibilities.

 

RELATED CLASSES

 

Resources and Reimbursement Program Development Specialists assist in developing and maintaining revenue and reimbursement programs; analyzing laws, regulations and policies; preparing policy and procedure documents; preparing position papers on legislative impact on agency policies; monitoring programs to improve fiscal resources and ensuring compliance with regulations; providing system support; and may participate in training and supervising, as well.

 

ILLUSTRATIVE DUTIES

 

RESOURCES AND REIMBURSEMENT AGENT 1

 

Secure financial information regarding patient population in order to assess the appropriate rate of charge.    

 

·        Research and evaluate the financial resources of individuals receiving services and financially liable relatives in order to establish appropriate schedules of charges for care and treatment.

·        Determine private party billing rates based on predetermined criteria, taking into consideration available income, assets, costs, and the availability of all other sources.

Assist individuals in determining and accessing health insurance coverage, income, and benefits.  

·        Review cases for eligibility for Social Security, Supplemental Security Income, veterans' benefits, pensions, or other types of disability payments.

·        Develop and submit enrollments and claims for Medicare, or other hospitalization or medical insurances, and maintain individuals eligibility for these programs.

·        Research and document eligibility as well as process Medicaid applications for eligible clients.

 

Protect individuals interests/resources.

 

·        Review accountings of committees, guardians, trustees, and representative payees to assure individuals interests have proper attention and that charges and expenditures are appropriate.

 

Make reimbursement determinations in more routine cases.

 

·        Prepare correspondence and make field visits to investigate financial resources as indicated by bank accounts, court records, county records, etc.

·        Review and take initial steps to resolve delinquent accounts.

·        Handle the financial aspects of residential and non-residential programs. 

·        Use and update various computer systems for inquiry and data collection; and maintain financial and billing and tracking systems for assigned caseload.

 

RESOURCES AND REIMBURSEMENT AGENT 2

 

May perform any and all duties of a Resources and Reimbursement Agent 1.

 

Assist Resources and Reimbursement Agents 1 in making determinations in the most complex cases (e.g., reimbursement situations where there are no clear precedents; cases involving complex benefit development, collection or legal proceedings).

 

May supervise subordinate staff.

 

·        Provide supervision, guidance, and oversight to subordinate staff, and intervene and resolve problems as necessary.

·        Determine and oversee staff assignments. 

·        Approve leave and track time and attendance.

·        Review, monitor, and evaluate staff performance. 

·        Complete performance evaluations.

·        Identify training needs and arrange for provision of training.

·        Manage and direct program activities by setting priorities and deadlines.

 

Review, audit, and protect individuals' financial resources and determine proper charge for care and treatment.

 

·        Ensure timely billing for assigned individual.

·        Determine the financial status of individual and liable relatives through personal inquiry and searches of public and bank records.

·        Evaluate financial and social factors as they bear on ability to pay.

 

Make determinations in the more complex cases involving disability benefits, hospitalization, or medical insurance and pensions, where there are not clear precedents.

 

·        Decide which cases demand guardian proceedings and take necessary action.

·        Meet with guardians, attorneys, relatives, and other interested parties concerning individuals' assets.

·        Handle cases involving monies administered through individuals' personal accounts to ensure that reserves are maintained, that charges are reasonable, and that the individual is adequately supplied with comfort necessities.

 

Assist in the investigation of apparent fraud or misappropriation of individuals' funds and recommend corrective action.

 

·        May handle delinquent accounts, interviewing, reviewing the facts, and validating settlements or compromise payments.

·        May investigate and attempt to collect delinquent payments.

·        Assist Resources and Reimbursement Agents 3 in carrying out liaison and contact responsibilities with assigned facilities, Central Office, and outside agencies and providers.

 

RESOURCES AND REIMBURSEMENT AGENT 3

 

May perform any and all duties of lower level Resources and Reimbursement Agents.

 

Responsible for the overall management and operation of a field or facility-based reimbursement office.

 

·        Handle appeals from determinations at the local level and settle as many as possible, forward the remainder to higher level staff for final determination.

·        Settle large estate claims requiring a high degree of knowledge and judgment.

·        Serve as liaison with facility directors, Main/Central Office, and outside agencies in regard to policy and joint or related procedures.

·        Keep supervisor informed of current status of the office and refer unresolved and/or important issues to him/her for attention.

·        Responsible for maintenance/retention of case files, production records, and attendance records.

·        Evaluate staffing, equipment, and supply needs of the office.

·        Review cases of possible fraud or mismanagement of individuals' assets and determine what steps may be necessary to recover resultant losses, including recommendations for court action.

·        Supervise, train, and monitor work performance of staff.

 

In the Office of Children and Family Services.

 

·        Establish duties, responsibilities, and priorities for Central Office and regional resources and reimbursement staff.

·        Provide direct supervision to Central Office Resources and Reimbursement Agents and clerical staff, and provide general supervision of regional field staff.

·        Periodically visit field office(s) and review operations.

·        Recruit, hire, and train resources and reimbursement staff.

 

RESOURCES AND REIMBURSEMENT AGENT 4

 

May perform any and all duties of lower level Resources and Reimbursement Agents.

 

Manage a central office revenue operation, and/or manage a group of field or facility‑based reimbursement offices in a major geographic region of the State.

 

·        Act as central office or regional revenue liaison with federal, State, and local agencies such as Social Security, Veterans Administration, Department of Health, Office of Temporary and Disability Assistance, Department of Social Services, etc., on questions related to policy and procedure.

·        Coordinate departmental policies and major procedures to ensure uniformity and consistency among the facilities and field offices within assigned region.

·        Develop Statewide program priorities and/or determine regional work priorities and work with higher level program/fiscal staff to determine the most effective assignment and utilization of personnel.

·        Direct subordinates in handling exceptional cases and/or cases which may have important policy or procedural impact.

·        Coordinate Statewide projects and/or regional in-service training programs and staff meetings.

 

MINIMUM QUALIFICATIONS

 

RESOURCES AND REIMBURSEMENT AGENT 1

 

Open Competitive:  six years of experience seeking determinations of persons receiving services eligibility for public assistance, which included locating public and/or private resources or case review. 

 

Substitution:  college study may be substituted for up to four years of the general experience at the rate of 30 college credits equaling one year of experience; or completion of the Resources and Reimbursement Agent Traineeship.

 

RESOURCES AND REIMBURSEMENT AGENT 2

 

Promotion: one year of permanent competitive service as a Resources and Reimbursement Agent 1.

 

RESOURCES AND REIMBURSEMENT AGENT 3

 

Promotion: one year of permanent competitive service as a Resources and Reimbursement Agent 2; or one year of service as a Resources and Reimbursement Agent 1.

 

RESOURCES AND REIMBURSEMENT AGENT 4

 

Promotion: one year of permanent competitive service as a Resources and Reimbursement Agent 3; or one year of service as a Resources and Reimbursement Agent 2.

 

 

 

 

 

 

Date:  11/09

 

 

 

 

 

 

NOTE: Classification Standards illustrate the nature, extent and scope of duties and responsibilities of the classes they describe.  Standards cannot and do not include all of the work that might be appropriately performed by a class.  The minimum qualifications above are those which were required for appointment at the time the Classification Standard was written.  Please contact the Division of Staffing Services for current information on minimum qualification requirements for appointment or examination.