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Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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Business Office Enhancement
 
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P D #

Supervisory Health Systems Specialist
G S-0671-11

I. INTRODUCTION
This position is located at the Winslow Indian Health Center, Winslow Service Unit (W S U), Winslow, Arizona. The facility is a general medical/outpatient/urgent care facility that provides preventative, acute and referral services to beneficiaries. Additionally, the Service Unit (S U) also operates two satellite clinics.

Incumbent serves as the Director of Business Office for the W S U. The Department consists of Patient Registration Staff, 3rd Party Billing Office, Voucher Examiner, Patient Benefits Coordinator, Accounting Technician (Cash Control), Budget Analyst and the Medical Records Department. The function of the Business Office Department is to integrate and assure an efficient system of timely billings and collections from health care resources, patient eligibility-determination, resource patient management, information resource management, training and oversight of the C H S revenues and expenditures. The purpose of the position is to manage, evaluate, plan and implement the above stated activities. Assignment requires professional experience and medically related judgement to perform planning reviews, program development, implementation, acquisition, technical assistance, and consultation of health care programs and managed care. Participates in strategic planning and implementation of both long and short - term policies, plans for the health care delivery system, monitors trends and patient volume. Advises Management Committee regarding aspects of both revenues and expenditures and reports on a regular basis to the Executive Management Committee and Governing Body.

II. SUPERVISORY RESPONSIBILITIES 80%
Exercises overall supervisory responsibility for the planning, development, organization, implementation, and evaluation of the Business Office. Develops, implements and evaluates fiscal activities that impact Business Office operations of the facility. The departments over which the position has authority include Medical Records and Business Office. Serves as the focal responsibility for program review. Determines the impact of reviews on outcomes and implements change. Develops and implements a Quality Improvement (Q I) process for the Department.

Exercises approval or disapproval authority of personnel actions required by subordinate Supervisors. Ensures that Supervisor implement the provisions of various government wide or agency programs such as Merit Promotion, Awards, career development plans, performance appraisals and others to achieve equitable treatment of employees and success of the mission. Approval/disapproval authority for personnel actions within the Department. Hears individual and group grievance, recommends actions.

The incumbent is responsible for the application and implementation of E E O program guidelines and the achievement of tangible results relative to minorities and women. Evidences affirmative action in all assignments and activities.

III. ADMINISTRATIVE RESPONSIBILITY 20%
1) Business Office (90%):
Incumbent is responsible for the overall requirements of the Business Office, including Medical Records activities that impact Billing, Fee Table, Activity Posting, Accounts Receivable management and the process for developing a compliance program. Understands the role of the activities as it relates to compliance issues such as Charge Masters, Fee schedules, Cost reports and so forth. Identifies the need for a systematic approach to analyze, assess and take action in areas related to coding, billing and reimbursement.

Identifies financial reprogramming needs in keeping with previously identified and newly discovered priorities. Monitors the rate of expenditures of funds available, informs the C E O, oversees the preparation of bills for medical services and other services incurred at the facility, requires separate registers for each financial activity at the S U. Develops recommendations with S U and program officials, participates with managers in the discussion of the impact on and adjustments to be made in program plans and objectives. Prepares a wide variety of financial and statistical reports and trends. Utilizes the patient database information system and integrates findings to formulate fiscal planning based on historical performance, trends and workload. Utilizes information to improve and optimize third party collections. Projects revenues and monitors relationship with expenditures. Collaborates with Area Third Party Consultant. Assures export of visit counts and registration information to optimize federal, state (Medicare and Medicaid) and Private Insurance reimbursement. Ensures the coordination of efforts among respective branches of the facility in activities and project as related to managed care. Implements appropriate Q I monitors to improve financial operations of the S U.

Is responsible for overseeing the implementation of the Medicare Compliance Program and Business Office Plan. This includes monitoring and evaluating activities through internal reviews and developing training programs for clinical and Business Office staff compliance. Reports outcome of Program Reviews and activities to the Executive Management Committee and Governing Body. 2) Medical Records (10%):
Provides supervision of the Medical Records Director. Assures the independent function and operation of the Medical Records department and oversees the integration of information with revenue. Incumbent is available for administrative consultation and discussion on matters of policy. Success or failure of the program can be directly related to the accuracy of information and timeliness of transfer of information to P C C for entry into the database. Advises C E O on matters related to the administration of the Medical Records Department. Incumbent directs long and short range planning, evaluation analysis, and projection of future information resource management requirements including changes in coding systems or requirements, federal filing standards, addition of A P G s (Ambulatory Patient Groups) and need for equipment to maintain state-of-the-art status.

Executes responsibilities for distribution of the workload, operational direction, review of productivity, internal reporting system, and employee counseling. Provides technical advice on programmatic matters related to revenue, unexplored areas of service, which have not been previously explored for reimbursement. Applies professional knowledge and education to understand the interrelationships between medical services rendered utilization review and collections from alternate resource. Promotes the marketing and outreach efforts of the S U and its program.

Special Assignments: Reports to the Executive Committee, Governing Body, Tribal Health Advisory Board and other committees as needed on matters related to Business Office activities such as revenue, Third Party billing, and others. Prepares special reports and research projects related to visit counts and patient volume, objective reviews concerning payroll methodology and various accounting activities.

Performs other related duties as assigned.

I V. FACTORS

Factor 1 – Program Scope and Effect:
The purpose of this position is to integrate finance, revenues and expenditures with multi-disciplinary matters ranging from funding to clinical issues for the improvement of financial revenue. The incumbent is responsible for complying with Federal & State regulations. The work is to provide standards, management, research and evaluation of Business Office activities for the overall successful financial management of the S U. The incumbent is management’s primary advisor on all matters related to the financial management of the S U and cost containment. Establishes policy and precedent.

Factor 2 – Organizational Setting:
The incumbent is the Director of Business Office at W S U. The employee’s supervisor is W S U’s, C E O.

Factor 3 – Supervisory and Managerial Authority Exercised:
The incumbent is highly independent under the Guidance of the C E O. The incumbent is expected to manage the Department and resolve all routine and unanticipated issues as they occur. Completed work is reviewed for accuracy and is reflective of the overall fiscal performance of the SU. C E O sets overall S U goals and the Director of Business Office is expected to achieve all goals by determining independent departmental strategic plans and priorities and taking action.

Incumbent exercises overall supervisory responsibility for the planning, development, organization, implementation, and evaluation of the Business Office & Medical Records Department. Develops and implements health center policies and procedures regarding Business Office activities and training methods. The Department which the position has authority includes the Medical Records Department. Serves as the focal responsibility for program review. Determines the impact of reviews on outcomes and implements change. Develops and implements a Quality Improvement process for the Division.

Exercises approval or disapproval authority of personnel actions required by subordinate supervisors. Ensures that supervisor implement the provisions of various government wide or agency programs such as Merit Promotion, Awards, career development plans, performance appraisals and others to achieve equitable treatment of employees and success of the mission. Approval/disapproval authority for personnel actions within the Department. Hears individual and group grievance, recommends action.

The incumbent is responsible for the application and implementation of E E O program guidelines and the achievement of tangible results relative to minorities and women. Evidences affirmative action in all assignments and activities.

Factor 4 – Personal Contacts:

Subfactor – Nature of Contacts:
Personal contacts include but are not limited to: Providers, nursing staff, department heads, general staff, administrative personnel, inter agency personnel, tribal and federal agency personnel, state and county representative, headquarters and N A I H S personnel, patients, families, the general public, utilization review nurses, business office personnel from facilities outside of I H S, Navajo County, State and Local A H C C C S workers and supervisors.

Subfactor – Purpose of Contacts:
The purposes of contacts are related to the exchange of information for either clinical or financial purposes. This may include: review of claims, status of collections, related projections, deadlines, interaction with providers, medical priority determination, financial planning, third party liability and tort claims, workmen’s compensation, application for provider status, budget activity, information management systems, vendor relations and payment information, the placement of county A H C C C S workers, reimbursement information and others. Networks resources for care and monitors health care contractors costs including the quality and appropriateness of services provided. Contacts may also include the discussion of legal matters related to reimbursement, the federal government’s right to collect, tort claims, and labor relations matters.

Factor 5 – Difficulty of Typical Work Directed:
The incumbent has overall supervisory responsibility for a staff of seven (7) in the Business Office Department. The department over which the position has authority includes Medical Records.

Direct supervision is to a staff of seven (7) that include:
1 Medical Records Administrator Specialist G S-0669-11
1 Patient Benefits Coordinator G S-0962-07
1 Voucher Examiner (Collect) G S-0540-05
2 Billing Technician G S-0503-06
1 Budget Analyst G S-0560-09
1 Accounting Technician (Cash Control) G S-0506-07

Exercises approval or disapproval authority of personnel actions required by subordinate supervisors. Ensures that supervisors implement the provisions of various government wide or agency programs such as Merit Promotion, Awards, career development plans, performance appraisals and others to achieve equitable treatment of employees and success of the mission. Approval/disapproval authority for personnel actions within the Department. Hears individual and group grievance, recommends action.

Factor 6 – Other Conditions:

  1. Variety of Work: Incumbent supervises and directs departmental units, which include Business Office and Medical Records and must have in depth knowledge of the workings and interrelated functions of each activity. Employees in these areas range from G S-05 to G S-11 levels, many with regulatory standards associated with them or various levels of professional certification. Employees perform all levels of semi-skilled, technical and professional activities associated with the capture of financial revenue and expenditure and the documentation of these activities.
  2. Shift Operations: General hours of operation are between 8:00 a. m. to 5:00 p. m. Monday through Friday, no Federal Holidays. Medical Records operates additional shifts 1:00 p. m. through 10:00 p. m. seven days a week, including weekends.
  3. Fluctuating Work Force or Constantly Changing Deadlines: The workforce is of a relatively consistent nature. Incumbent is responsible for the long term planning required to insure coverage for Business Office related activities. Sudden illness, personal emergencies, and unplanned statistical support requested by the C E O or Area Office could require the adjustment of staffing levels. There are predictable incidents at the close of each fiscal year that require adjustments to the workload and redistribution of staff to assure completion of job requirements.
  4. Physical Dispersion: All Work areas are located in the two different buildings. The Medical Records Department is an independently sequestered area at the West End of the building, on the first floor. It is controlled entry and off limits to anyone not authorized. Also on the first floor, near the Medical Records area is a section containing Patient Registration, Data Entry and the Benefits Coordinator. This area is a major patient access area. The incumbent’s office along with 3rd Party Billers, Budget Analyst and Accounting Technician (Cash Control) are located in the Administration building. The incumbent must frequent all areas on a daily basis.
  5. Impact of Specialized Programs: Medical Records and Clinical Departmental activities impact on the operation of the Business Office. The functioning of the Business Office impacts on overall Service Unit operations related to fiscal activity.
  6. Changing Technology: Changing technology impacts all departments and employees in the Department heavily. This includes the continual, annual update of M I S; database information for billing and regulatory activity, the predictable annual federal changes in D R G weights and the need for reprogramming the system. There is an unavoidable growth simply within computerized technology that requires employees be trained and able to utilize different software programs and R P M S database upgrades. Planning and assurance of the training is essential. Long term planning for changes in the H C F A billing process by A P G codes is required. Incumbent must remain, current, trained and updated on changes in state-of-the-art medical technology to assure both quality and fiscal necessity for care delivery. Billing personnel must also be updated in improved medical technology.
  7. Special Hazard and Safety Conditions: Limited risk of contact with electrical office equipment producing shock hazard.