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Area Standard Position Description 881300
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.
II. MAJOR DUTIES AND RESPONSIBILITIES:
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
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
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
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
- Independently determines the types and sources of information
needed to complete the transaction.
- The nature and extend of deviation from established requirements;
- Whether standard techniques, methods or procedure are appropriate
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
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
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
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,
Factor 9 – Work Environment
All functions related to this position are normally performed in
the business office setting.
IV. OTHER SIGNIFICANT FACTS:
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.