Patient Care Reimbursement Investigator I

GENERAL STATEMENT OF DUTIES AND RESPONSIBILITIES

The Department of Mental Health (DMH) is seeking a dynamic individual to serve as Patient Care Reimbursement Investigator (PCRI). The ideal candidate provides financial assistance to patients and the facility by ensuring that all entitlements and insurances are current to support the patient and assist the facility in billing.

Please note: This position is full time, 40 hours per week 8:00am-4:30pm. Days off: Saturday-Sunday

Duties and Responsibilities (These duties and responsibilities are not all inclusive):

• Works within the Department of Clinical Social Work Department assuming responsibility for all patient financial assistance, including but not limited to:
  • Meets with patients for purpose of gathering information and completing all relevant financial forms.
  • Works with patients to make application for SSI, Social Security, and General Relief benefits when appropriate and/or reinstating benefits that may have been in suspended status.
  • Works with patients and patient families to apply for all Medicaid /Mass health /Medicare coverage for hospital reimbursement; discharge planning, nursing home placement and/or general hospital admittance.
  • Research patient entitlements for financial assistance.
  • Communicates information to Department of Public Health (DPH) treasurer’s office that in turn bills for services as per regulations.
  • Provides DPH, Medicaid, Mass Health, Medicare etc. with appropriate forms to allow for billing in a timely manner as per regulations.
  • On an as needed basis, meets with DPH treasury staff and with CSW supervisory staff to ensure good communication and problem solve issues, which arise.
• Participates in the planning and implementation of expenditures of various funds in consultation with the Treatment Teams, families and/or guardians.
• Attends Morning Rounds to learn about new admissions and pending discharges and maintain current information re: patient’s clinical status. Attends treatment team meetings as needed for successful collaboration with patient and team related to patient’s request for funds and ability to manage funds.
• Follows DMH guidelines as specified in DMH policy on Patient Funds #96-4, meeting all timeframes for assessments forms and documentation.
• Provides ancillary supportive services to patients and families by performing routine liaison functions with relevant community agencies and Tewksbury Hospital departments to ensure patient access to appropriate financial and medical insurance benefits.
• Communicates by phone and/or letter regularly with all relevant persons and agencies to ensure maximizing patient entitlement programs.
• Monitors expenditures on behalf of all patients on assigned units by maintaining highly detailed records, bookkeeping and accounting functions for purpose of safe-guarding patients’ funds. Works collaboratively with other PCRIs in the department to audit each other’s books as per policy and provide coverage during planned/unplanned absences.
• Distributes and updates patient funds (from patient requisitions, Perry Fund, etc.) for provision of basic needs, including clothing and personal allowance in accordance with the patient’s budget.
• Coordinates with providers, guardians, and representative payees, as needed, and may assist patients in shopping for personal needs.
• May retain patient valuables, with appropriate documentation, to ensure safety or send to Tewksbury Hospital vault.
• Responsible for acquiring necessary patient financial information to bill for services, conveying to Tewksbury Revenue Office and working efficiently and cooperatively with that department.
• Will perform a limited amount of regularly scheduled, structured direct service as time allows, including a minimum of one psychoeducational group within the hospitals on unit rehabilitation program, to be determined by the supervisor.
• Purchases items for patients, if necessary; with team and/or family approval as needed; maintains receipts and records.
• May be required to produce reports and design forms for the Assistant Chief of Psychiatric Operations.
• Required to develop skills with computer software related to financial and legal tracking and hospital medical record.
• Other duties as assigned by the Assistant Chief of Psychiatric Operations.
• Compliance with all applicable state and federal laws including the Health Insurance Portability and Accountability Act (HIPAA) regulations which governs the privacy and confidentiality of information about patients.

Preferred Qualifications:

• Given the population served, bilingual or multilingual fluency
• Experience working with the mentally ill, behavioral challenged and disabled populations.
• valid drivers license

About Tewksbury Hospital:

Tewksbury Hospital operates a 370-bed facility and a campus of over 700 acres of land. Its patient care services are provided under the auspices of the Department of Public Health and Mental Health. Joint Commission accredited LTAC hospital that provides high quality, comprehensive treatment, care, and comfort to adults with chronic medical and mental illness. A full range of services are provided including 24/7 Nursing, Nurse Practitioners, Medicine as well as psychiatric and psychological services, a 6- bed dialysis unit, clinical laboratory, radiology, respiratory care, nutrition, speech/language, pathology, occupational therapy, physical therapy, therapeutic recreation and arts, and pharmacy.

Learn more: https://www.mass.gov/locations/tewksbury-hospital

DMH Mission Statement:

The Department of Mental Health assures and provides access to services and supports to meet the mental health needs of individuals of all ages, enabling them to live, work and participate in their communities. The Department establishes standards to ensure effective and culturally competent care to promote recovery. The Department sets policy, promotes self-determination, protects human rights, and supports mental health training and research.

Pre-Hire Process:

A criminal background check will be completed on the recommended candidate as required by the regulations set forth by the Executive Office of Health and Human Services prior to the candidate being hired. For more information, please visit http://www.mass.gov/hhs/cori and click on "Information for Job Applicants."

Education, licensure and certifications will be verified in accordance with the Human Resources Division’s Hiring Guidelines.

Education and license/certification information provided by the selected candidate(s) is subject to the Massachusetts Public Records Law and may be published on the Commonwealth’s website.

For questions about this requisition, please contact Employment and Staffing Customer Service at 1-800-510-4122, option 4.

Questions or issues regarding access/login credentials to MassCareers, please contact the Mass HR ESC at 617-979-8500.

First consideration will be given to those applicants that apply within the first 14 days.

Minimum Entrance Requirements: None:

SPECIAL REQUIREMENTS: Based on assignment, possession of a current and valid Massachusetts Motor Vehicle Operator's License may be required.

Salary placement is determined by a combination of factors, including the candidate’s years of directly related experience and education, and alignment with our internal compensation structure as set forth by the Human Resources Division’s Hiring Guidelines. For all bargaining unit positions (non-management), compensation is subject to the salary provisions outlined in the applicable collective bargaining agreement and will apply to placement within the appropriate salary range.

Comprehensive Benefits

When you embark on a career with the Commonwealth, you are offered an outstanding suite of employee benefits that add to the overall value of your compensation package. We take pride in providing a work experience that supports you, your loved ones, and your future.

Want the specifics? Explore our Employee Benefits and Rewards!

Title 101 CMR 23.00 (“Regulation”) requires certain agency staff to have received the COVID-19 vaccination and Influenza vaccination, or have taken required mitigation measures, to prevent viral infection and transmission in State Hospitals and State Congregate Care Facilities. The Regulation applies to this position. Successful candidates will be required to acknowledge and attest to your vaccination status for both COVID-19 and Influenza.