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Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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G S -525-05

This position is located in the Fort Defiance Service Unit, Division of Administration and Management, Business Office Service Branch, Finance Section. The primary purpose of this position is to perform a major segment of technical budgetary and accounts receivable support functions to the Budget/Accounting and Patient Accounts sections.

Maintains identified corrective action received from Fiscal Intermediaries or third party payers to be shared of communicated with the Utilization Review Coordinator for review of diagnosis, length of stay, or coding transaction for possible reconsideration and appeal for payment.

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

Maintains the accounts receivable ledger and associated records and documentation in the I H S accounting system. Receives, reviews and reconciles for correct data and processes collection schedules; liquidates necessary accounts receivables. Computes and prepares adjustments in the local automated accounts receivable programs.

Incumbent safeguards the contents of the Alternate Resources program health insurance claims and Medical Records as a privileged communication with disclosure of information only within the limits of I H S policy. Completes special projects within required time frame to ensure compatibility of project specifications.

Performs routine recurring budget duties which facilitate the conduct of more complex and detailed review and analysis by the Finance Officer and Business Office Manager. Work performed by the incumbent supports the budget expenditures transactions for the Fort Defiance Service Unit, through appropriated and collected funds.

Gathers extracts, reviews, verifies and consolidates a variety of reimbursement information and statistical data needed in the formulation and presentation of fiscal data.

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.

Supervise the filing of all pending and completed health insurance claims and correspondence relative to the third party and primary care provider programs.

Maintains Medicare/Medicaid and Private Insurance manuals, and directives; Provider Reimbursement Manual; Direct dealing Provider Letters; Federal Health Insurance for the Aged; Transmittal of Bills; Vouchers and Schedules and any addendum to the I C D-9-C M coding Volumes.

Factor 1 - KNOWLEDGE REQUIRED BY THE POSITION: Level 1-3 350 points
Knowledge and understanding of established and standardized bookkeeping and accounting procedures and techniques sufficient to handle duties such as classifying accounting records in an accounting system. Classifying a group of related transactions which regularly affects a small number of control accounts, that is, 6 to 10, and a number of subsidiary accounts which must be properly identified and which include recurring types of adjustments for which procedures are well established.

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

Knowledge of total program, operation, the priorities and goals of the Alternate Resources program. Keeps abreast of current changes in policies regulations on eligibility, medical terminology, anatomy and physiology, diagnostic and financial coding. Participates in planning, implementation, and improvements of the Alternate Resources program.

Working knowledge of I C D-9-C M coding procedures, abbreviations and terms used in the I C D-9-C M coding volumes and A M A C P T-4 coding system in order to acquire, interpret and resolve problems based on information derived from system monitoring reports to carried over the U B-82 and/or H C F A 1550 forms.

Knowledge of established procedures, required forms, etcetera, associated with various health insurance programs.

Knowledge of, and the ability to apply the Alternate Resources regulations; P. L. 94-437, Title IV of Indian Health Care improvement Act, I H S 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: Level 2-3 350 points
The incumbent works under the general supervision of the Finance Officer who establishes general guidance and advice, and suggests techniques for handling unusual or nonrecurring situations which have no clear precedents.

Incumbent independently plans and carries out the successive steps and handles problems and minor deviations in the work assignments in accordance with instructions, policies, etcetera.

Factor 3 - GUIDELINES: Level 3-3 275 points
A number of substantive guidelines are utilized by the incumbent. 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: Level 4-3 150 points
The incumbent determines how each budgetary and accounting transaction should be processed in accordance with available guidelines and instructions, and adjusts accounts to reflect net gains and losses. The incumbent decides at each stage of the transaction whether proper procedures are being followed.

There are a wide variety of appropriated and reimbursable fund transactions, which require the incumbent to identify and adjust into related accounting codes.

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. The work involves working with various outside agencies in regard to third party resources, that is, Insurance Companies, Medicare and Medicaid eligibility workers and other health care professions. Analyses and evaluates accounts of bill submitted for payment. Provides recommendations for improving collections on all outstanding bill, utilizing the automated accounts receivable program. Provides statistical analysis of all outstanding bills, closed accounts, and accounts unresolved. Reimbursement statistical reports will be submitted on a monthly basis. These reports will be reconciled with Navajo Area Finance Collection Reports.

Factor 5 - SCOPE AND EFFECT: Level 5-2 75 points
The incumbent assists in maintaining the balances, and reconciles the funds collected which are used by the Service Unit and Area Office programs for projects, and planning purposes, which aids the overall objective to elevate the health status of Indian beneficiaries. The successful efforts of the incumbent directly affects the funds collected.

Factor 6 - PERSONAL CONTACTS: Level 6-2 25 points
The incumbent has regular and recurring contacts employees in the same agency, state and local agencies, health insurance carriers, Fiscal Intermediaries, etc.

Factor 7 - PURPOSE OF CONTACTS: Level 7-2 50 points
The purpose of these contacts are to plan and coordinate the work of the office, resolving problems regarding billing claims and following up to ensure that required actions are completed and resolving differences in costs of initial reimbursements presented for health care services provided.

Factor 8 - PHYSICAL DEMANDS: Level 8-1 5 points
The work is primarily sedentary with some carrying of computer reports and ledgers. Occasional walking is required since interaction between all disciplines within the facility is required.

Factor 9 - WORK ENVIRONMENT: Level 9-1 5 points
The work is usually performed in an 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 come 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.

{s t d} Employees in this series classify accounting transactions, maintain and reconcile accounts; close accounts and prepare reports and statements; analyze accounting data; and examine accounts. Accounting technicians classify accounting transactions that include verifying the accuracy and completeness of the accounting data; determining the general ledger accounts, journals, and subsidiary accounts affected and the debit and credit entries to be made. They also summarize transactions and prepare control documents or other posting documents reflecting the entries to be made. Accounting technicians maintain accounts by reviewing documents to verify accounting data as necessary, entering data into the system, and taking a trial balance. 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 into balance. They close accounts and prepare balance sheets and financial statements. They also abstract data reflecting financial condition and operating results; and present this data in the form of statements and reports. Accounting technicians examine accounts to verify the accuracy of accounts and adequacy of supporting data. They also prepare worksheets or reports reflecting the examinations made, discrepancies noted, and the corrective entries required to adjust accounts. Some accounting technicians review the efficiency of clerical processes and compliance with prescribed procedures, and recommend improvements such as the need for coordination, additional training, or clarification of procedures to reduce errors or processing delays.