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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

G S-525-05

This position is located in the Navajo Area I H S Service Unit, Division of Administration and Management, Business Office Branch. The primary purpose of this position is the overall responsibility for a major segment of the accounts receivable management function. This responsibility includes the submission of properly executed claims on a timely basis to third payers and responsible parties and rebilling or corrected billing of accounts previously submitted.

Responsible for the accurate and timely preparation and submission of claims to third party payers, intermediaries, and responsible parties according to established hospital policy and procedures.

Responsible for maintenance and control of unbilled claims for an assigned section of patient receivables.

Responsible for verification that all control functions assigned are maintained daily as set forth in hospital policy and procedures.

Reviews system generated reports daily to identify claims that are ready for billing. Prepare and submit claims to third party payers, intermediaries or responsible parties within 24 hours after all information for billing becomes available.

Responsible for the error correction for all rejected/suspended claims previously submitted to third party payers and intermediaries and patients according to hospital policy and procedures.

Notifies supervisor of all claims deemed unbillable, along with reason(s) on a daily basis.

Documents of all activity performed on patient accounts in the patient financial folder such as date billed and to whom.

Provides supervisor with an accurate accounting of all claims in the assigned section of patient receivables responsible for. Submits a Daily Billing Productivity Report reflecting the beginning inventory, claims and remaining balance at end of shift.

Responsible for self-education by reading all third party newsletters, periodicals and updates circulated by management. Attend all continuing education opportunities made available.

Knowledge and understanding of established and standardized business office procedures and hospital policies sufficient to handle duties such as listed in section II of this document.

Through knowledge of all third party claims submission process and attendance at continuing education opportunities made available through management to stay current on changes.

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 in 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 how to establish and maintain relationships with the third party payer community necessary for resolution of outstanding claims.

Knowledge of the on-line input terminal equipment and automated electronic billing system(s) established procedures, formats, etc., associated with the various 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 4236.21 (A) and 23 (F), and P. L. 99-272, Federal Medical Care Cost Recovery Act.

Factor 2 – Supervisory Controls:
The incumbent works under the general supervision. The supervisor establishes general guidance and advice, and suggests techniques for handling unusual or nonrecurring situations, which have no clear precedents.

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

Factor 3 – Guidelines:
The incumbent utilizes a number of substantive guidelines. The incumbent uses judgement in locating a 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:
The incumbent determines how each billing step should be performed in accordance with available guidelines and instructions, and direction of supervisor.

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

Factor 5 – Scope and Effect:
The incumbent assists in the submission of claims to third party resources and appropriate responsible parties for services rendered to Indian Beneficiaries and Non-Beneficiaries alike. The resulting funds collected and posted are used by the Service Unit and Area Office programs for projects and planning purposes, which aid the overall objectives 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 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 claims submission function of the business office, resolution of problems retaining to billing of claims and to resolve issues for any return claims for services rendered to Indian Beneficiaries and Non-Beneficiaries alike.

Factor 8 – Physical Demands:
The work is primarily sedentary with the following physical requirements; Ability to lift up to 25 pounds, walk/stand for a 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, for example, to operate office equipment such as computer, calculator, printer, fax, etc.

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.