STATE CLASSIFICATION JOB DESCRIPTION


Salary Group B16

Class No. 1246

REIMBURSEMENT OFFICER III

GENERAL DESCRIPTION

Performs highly complex (senior-level) reimbursement or claims processing work.  Work involves performing, coordinating, and/or monitoring billing and collection activities.  May supervise the work of others.  Works under limited supervision, with considerable latitude for the use of initiative and independent judgment.

EXAMPLES OF WORK PERFORMED

Coordinates and/or performs financial interviews, financial investigations, asset research, and fee determinations.

Coordinates and monitors billing and collection activities.

Conducts reviews to monitor compliance with state and federal laws, rules, and regulations pertaining to reimbursements that are highly complex in nature or large in scale.

Conducts investigations that are highly complex in nature or large in scale and determines amounts to be charged for care and treatment based on findings.

Assesses training needs based on observations and monitoring of reimbursement programs. 

Determines proper payment, collection of charges, and issuance of payment on claims.

Establishes charges and procedures for the collection of accounts.

Processes protests and appeals.

Resolves billing problems and financial determinations.

Assists in establishing policies and procedures.

May supervise the work of others.

Performs related work as assigned.

GENERAL QUALIFICATION GUIDELINES

Experience and Education

Experience in claims processing and health-related account and collection work.  Graduation from a standard senior high school or equivalent is generally preferred.  Experience and education may be substituted for one another.

Knowledge, Skills, and Abilities

Knowledge of the principles of collection and accounting, and of the rules and regulations governing reimbursement for agency services.

Skill in interviewing techniques, in the use of general office equipment, and in the operation of computers and applicable computer software.

Ability to communicate effectively and to supervise the work of others.


State Auditor’s Office

Revised 9-1-17