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Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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Area Standard Position Description 881300

(Cash Control)

G S-525-05

This position is located in a Navajo Area I H S Service Unit, Division of Administration and Management, Business Office Branch. The primary purpose of this position is to perform a major segment of the accounts receivable support function through the posting of payments and adjustments to the account receivable in the Patient Accounts section.

Maintains accounts by reviewing documents to verify accounting data as necessary, entering data into the system. They reconcile accounts comparing account balances with related data to assure agreement; reviewing records and source documents to identify the sources of discrepancies; and determining the entries required to bring the account to balance. Prepare reports reflecting the examination made, discrepancies noted, and the corrective entries required adjusting accounts.

Performs work consisting of examination for accuracy of claims and other request for payment for (1) services provided by the Government; (2) reimbursement of expenditures made by beneficiaries and non-beneficiaries for such purposes as medical care and treatment.

Maintain the automated accounts receivable ledger associated with third party payer claims. Responsible for associated records and documentation. Reviews and reconciles all third party payer documents for correct data, on all third party vouchers for accurate claims number.

Prepares monthly, quarterly and annual reconciliation and recapitulation of third party billing to assure that collections, billed data, and the computerized and manual reports are in balance.

Reviews and examines various bill types, of patient care to third party payers and performs third party collection posting to the automated account receivable program. Receives and reviews all Explanation of Benefit and remittance from third party payers. Identifies and records proper claims numbers on each remittance and post to the appropriate account.

Responsible for the posting of all contractuals/adjustments related to and in conjunction with posting of payments in accordance with hospital policy and procedures. Monitor accounts balances, review posting to ensure accuracy and recommend appropriate corrective action.

Audit all documents received for completeness and accuracy; analyze and select guide to determine whether payments are full or partial in accordance with hospital policy and procedures; whether they are timely; and whether remittance are advances, installments, or supplements.

Maintains current documentation and guidelines pertaining to reimbursement activities in appropriate files, binders, etc., and ensures preparation and distribution of copies to all appropriate disciplines.

Incumbent safeguards the contents of the alternate resources program health insurance claims as privileged communication which disclosure of information only within the limits of HIS policy.
Completes special projects within required time frame to ensure compatibility of project specifications.

Verify the accuracy of payment history for the period involved, determines the extent of underpayment or overpayment, if any. Responsible for assisting in the timely resolution of unidentified cash received by the hospital according to hospital policy and procedures.

Factor 1 – Knowledge Required by the Position
Knowledge of total program, operation the priorities and goals of the Alternate Resources program. Keeps abreast of current changes in policy regulations on eligibility. Participates in planning, implementation, and improvement of the Accounts Receivable Program.

General knowledge of third party payer reimbursement logic and of the total accounts receivable management program. Excellent communication skills are required for interaction with the third party payer community.

Knowledge and understanding of established and standardized accounting procedures and techniques sufficient to handle duties assigned.

Knowledge of a variety of accounting transactions and documents, accounting symbolic codes, account structures, and procedures for setting up and crediting accounts receivables.

Working knowledge of I C D-9-C M and C P T / H C P C S coding terms in order to interpret and resolve problems based on information derived from system monitoring reports and the U B 92 and H C F A-1500 billing form submitted to the third party payer.

Knowledge of the established procedures, reimbursement formats, etc., associated with the various reimbursing third party payers.

Knowledge of automated systems, ability to type, and operate a calculator.

Knowledge of, and the ability to apply the Alternate Resources regulations; P .L. 94-437, Title IV of Indian Health Care Improvement Act, Indian Health Service Policy and Regulations on Alternate Resources, C F R 42-36.21 (A) and 23 (F), and P. L. 99-272, Federal Medical Care Cost Recovery Act.

Factor 2 – Supervisory Controls
The incumbent works under the supervision of the Business Office Manager or designee. Supervision establishes general guidance and advice, and suggests techniques for handling unusual or nonrecurring situations, which have no clear precedents.

Incumbent uses initiative to perform recurring assignments. Refers situations not covered by instructions or precedents to the supervisor or designee for decision or help. Works independently processes the most difficult procedural and technical tasks or actions and handles problems and deviations in accordance with instructions and policies.
- Independently determines the types and sources of information needed to complete the transaction.
- The nature and extend of deviation from established requirements; and
- Whether standard techniques, methods or procedure are appropriate for assignments.

Factor 3 – Guidelines
The incumbent uses judgement to interpret guidelines, adapt procedure, decide approaches, and resolve specific problems. The incumbent uses judgement in locating and selecting the most appropriate guidelines, references and procedures for application and in making minor deviations to adapt the guidelines to specific cases.

Factor 4 – Complexity
Incumbent makes recommendation for claims, verify factual data, or make other determinations based on case by case review of the pertinent regulations, documents, or issues involved in each assignment or situation.

The incumbent determines how each step of the accounts receivable process should be performed in accordance with available guidelines and instructions, and proceeds accordingly. The incumbent decides at each stage of the process whether proper procedures are being followed.

The accounting technician process consists of duties that involve different and unrelated processes and methods. The complexity of the work involves working with remittances received from various programs, covering several states and third party payers who have different benefits and remittance formats.

Patient Account support consists of duties that involves different and unrelated processes and methods, the complexity of the work involves working with various programs which cover different states, with each health insurance program having different benefits, deductible, and eligibility requirements.

Factor 5 – Scope and Effect
The incumbent work affects the quality, quantity, and accuracy of the organization’s records, program operations and service to clients. Effect of the work ensures the integrity of the overall accounts receivable program, its basic design and the adequacy of the overall operation of the Business Office and various operating programs.

The incumbent assists in the posting of payments and contractuals/adjustments due for services rendered to Indian Beneficiaries and Non-Beneficiaries alike. The funds collected and posted are used by the Service Unit and Area Office programs for projects and planning purposes, which aid the overall objective of elevating the health status of Indian beneficiaries. The successful efforts of the incumbent directly impact the funds collected.

Factor 6 – Personal Contacts
The incumbent has regular and recurring contact with employees of within the hospital, local and state agencies, third party payers and Medicare and Medicaid fiscal intermediaries.

Factor 7 – Purpose of Contacts
The purpose of the personal contacts are to plan and coordinate the work of the cash posting function of the business office, resolution of problems pertaining to the posting of remittances and contractuals/adjustments to the patient receivable, and to resolve any unidentified remittances received for health care services rendered.

Factor 8 – Physical Demands
The work is primarily sedentary with the following physical requirements; Ability to lift up to 25 pounds, walk/stand for short periods of time as interaction between all disciplines with in the facility is required, ability to stoop and pick up objects from the floor without restrictions, and have full use of hands and arms, that is, to operate office equipment such as computer, calculator, printer, fax, etcetra.

Factor 9 – Work Environment
All functions related to this position are normally performed in the business office setting.

The Privacy Act of 1974 mandates that the incumbent shall maintain complete confidentiality of all administrative, medical and personnel records and all other pertinent information that comes to his/her attention or knowledge. The Privacy Act carries both civil and criminal penalties for unlawful disclosure of records. Violations of such confidentiality shall be cause for adverse action.