This information is for reference only. These classifications are no longer valid and were replaced 7/1/2020.
This is mid-level technical and supervisory work directing a reimbursement program of substantial scope and complexity involving the investigation of the financial resources of recipients of health and mental health services to obtain reimbursement for the cost of care and treatment.
Applicants must meet one of the following eligibility requirements:
(The following minimum qualifications will determine merit system eligibility. Allowable experience and education substitutions are provided in italics below the corresponding minimum qualification statement; no other substitutions will be permitted. These minimum qualifications may also be used to evaluate applicants for Missouri Uniform Classification and Pay System positions not requiring selection from merit registers.)
One or more years of experience as a Reimbursement Officer I with the Missouri Uniform Classification and Pay System.
OR
A Bachelor's degree from an accredited college or university with a minimum of 15 earned credit hours in one or a combination of the following: Public or Business Administration, Accounting, Economics, or a closely related field; and,
Two or more years of experience in health services billing, financial investigation, public or private health insurance claim filing, or a closely related area; including one or more years in the investigation of financial resources of clientele or determination of the ability to incur additional financial obligations.
(Additional qualifying experience may substitute on a year-for-year basis for deficiencies in the required education.)
This description may not include all of the duties, knowledge, skills, or abilities associated with this classification.
Supervises technical and clerical staff engaged in financial interviewing, financial investigations, asset research, and fee determinations.
Monitors reimbursement activities and resolves billing problems to ensure program effectiveness and integrity.
Conducts informal on-the-job training for technical and clerical staff.
Conducts investigations of sensitive and/or complex cases; determines amounts to be charged for care and treatment based on investigational findings and prescribed procedures.
Interviews recipients and/or financially responsible persons to gather information concerning available resources for payment of care and treatment and obtain reimbursement for the State.
Communicates with recipients' relatives, employers, financial institutions, insurance companies, and other persons or organizations to gather information concerning financial resources available to recipients which may be applied to their cost of care, treatment, and personal needs.
Serves as liaison with representatives of the Social Security Administration, Veterans Administration, and other federal, state, local government, and private agencies to obtain and maximize reimbursements.
Reviews deeds, wills, trust documents, probate court records, and other official documents for evidence of property and other financial resources available for the care, treatment, and personal needs of recipients.
Testifies for the department in probate court hearings.
Explains billing procedures and purpose of the reimbursement program to recipients and financially responsible persons.
Exercises considerable discretion and independent judgment in decision making within the limits of established policies, directives, and regulations.
Performs other related work as assigned.
Intermediate knowledge of regulations and policies pertaining to reimbursement functions.
Intermediate knowledge of regulations pertaining to benefits available to recipients through the Social Security Administration, Veterans Administration, and public and private health insurance.
Intermediate knowledge of the methods used in conducting financial interviews and investigations.
Intermediate knowledge of accounting and/or bookkeeping procedures and billing activities.
Intermediate knowledge of probate court records relating to the evaluation of available resources.
Ability to comprehend, interpret, and explain policies, rules, regulations, procedures, and requirements pertaining to the reimbursement program.
Ability to plan and supervise the work of technical and clerical staff.
Ability to train personnel in policies, forms, and procedures of the reimbursement program.
Ability to compile clear and concise reports.
Ability to obtain facts by personal contacts and interviews, and by reviewing official records and documents.
Ability to establish and maintain effective working relationships with other employees, agencies, and the general public.