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Area Standard Position Description
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.
II. MAJOR DUTIES AND RESPONSIBILITIES:
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.
Factor 1 – KNOWLEDGE REQUIRED BY THE POSITION:
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
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
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
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
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
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
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.
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.