This information is for reference only. These classifications are no longer valid and were replaced 7/1/2020.
This is senior-level supervisory and administrative work directing the largest and most complex reimbursement programs in mental health facilities, or work of comparable responsibility developing, implementing, and monitoring a reimbursement instructional program for state facilities and vendor agents.
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 II, or three 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,
Four or more years of experience in health services billing, financial investigation, public or private health insurance claim filing, or a closely related area; including three 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 Reimbursement Officers and clerical staff engaged in financial interviewing, financial investigations, asset research, and fee determinations.
Conducts on-site reviews of department and vendor reimbursement offices to monitor compliance with federal and state laws, rules, and regulations pertaining to reimbursements.
Monitors reimbursement activities and resolves billing problems and financial determinations to ensure program effectiveness and integrity.
Conducts investigations of sensitive and/or complex cases; determines amounts to be charged for care and treatment based on investigational findings and prescribed procedures.
Develops, implements, and conducts statewide instructional programs for state facilities and vendor agent employees.
Assesses training needs based on observations and monitoring of reimbursement programs; provides training improvement recommendations to management.
Represents the department in probate court hearings when technical advice is required by legal counsel.
Exercises considerable discretion and independent judgment in decision making.
Performs other related work as assigned.
Comprehensive knowledge of laws, rules, regulations, and policies pertaining to reimbursement functions.
Comprehensive knowledge of federal entitlement programs including, but not limited to, eligibility requirements, application process, and appeal process on denials of benefits.
Comprehensive knowledge of private and public health insurance programs.
Intermediate knowledge of probate court records, trust documents, and estate records pertaining to recipient financial resources.
Intermediate knowledge of accounting and/or bookkeeping procedures and billing activities.
Ability to comprehend, interpret, and explain policies, rules, regulations, procedures, and requirements pertaining to the reimbursement program.
Ability to train personnel in policies, forms, and procedures of the reimbursement program.
Ability to obtain facts by personal contacts and interviews, and by reviewing official records and documents.
Ability to communicate effectively.
Ability to compile clear and concise reports.
Ability to establish and maintain effective working relationships with other employees, agencies, and the general public.