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LEAD MEDICAL CLERK (Office Automation)
The position is located in the Business Office Services, Patient
Registration Section at the Crownpoint Healthcare Facility. The
incumbent serves a Lead Medical Clerk and works in various clinical
settings (that is, Ambulatory Care, Emergency Unit, Inpatient Unit
A / P / O B , satellite clinic Pueblo Pintado and Thoreau Clinic,
Optometry, Dental, New Horizon, speciality clinic and Triage) on
a rotation basis and provides assistance in determining eligibility
for direct care services, obtaining registration (demographic and
third party) information. Eligibility status is coordinated with
the Utilization Management Program.
II. MAJOR DUTIES AND RESPONSIBILITIES:
Lead Responsibilities: (40%)
Assigns work to employees and explains work requirements, methods and procedures
as needed. Insures timely performance of a satisfactory quality and quality
of work. Reviews work product of employees and accepts, amends or rejects
Distributes and balances the workload among employees in accordance
with established work flow. Assures timely accomplishment of the
Keeps in touch with the status and progress of work, and makes
day-to-day adjustments in accordance with established priorities,
obtaining assistance from the supervisor on problems that may arise,
such as backlogs which cannot be handled promptly.
Estimates and reports on expected time of completion of work,
and maintains records of work accomplishments and time expended
and prepares reports as requested.
Instructs employees in specific tasks and job techniques and make
available written instructions, reference materials and supplies.
Provides on the job training to new employees in accordance with
established procedures and practices.
Keeps employees informed of procedures, policies, directives,
etcetera, and informs employees of available services, latest program
developments and/or changes and employee activities.
Checks on work in progress or spot checks work not requiring review
and reviews completed work to see that supervisor’s instruction
on work sequence, procedures, methods and deadlines have been met.
Amends or rejects work not meeting established standards, refers
to supervisor questions or matters not covered by standards and
problems in meeting performance standards.
Approves leave for a few hours or for emergencies.
Reports to supervisor on performance, progress and training needs
of employees, and on disciplinary problems. Provides information
to supervisor regarding performance of staff as it may influence
promotions, reassignments, awards, disciplinary actions, and other
Technical Duties: (60%)
Interviews patients to obtain pertinent patient registration information,
that is, demographic and alternate resource information and pre-certification
or prior authorizations for care to enable the Business Office
to bill for health care services provided from all alternate resources,
Assist patients in completing new or updated forms for the Patient
Registration System (R P M S). This includes inpatients, outpatients,
emergencies and after-hour patients, specialty clinics, dental
and mental health patients.
Determines the eligibility of patients seeking health care, who
have not been treated at the facility, by obtaining the certificate
of Indian Blood or other documentary proof of tribal membership,
according to I H S guidelines.
Identifies those patients whose health benefits are subject to prior approval
to determine the extent of health care for both inpatient and outpatient. Obtains
and verifies the health records and the R P M S system for Medicare, Medicaid
and private/commercial insurance eligibility information for all patients seen
prior to all clinic visits.
Obtains all necessary signatures for file on required form(s)
for alternate resources and contract health services prior to patients
being seen in the clinic for billing purposes and/or contract health
In the event of claim information discrepancy; determines source
of discrepancy and implements corrective action as appropriate
to ensure that the claims can be processed for payment.
Collects third party, private insurance cards, Medicaid cards
or other health care cards, photocopies and explains the program
to the beneficiaries, that is, Medicare, Medicaid, A H C C S, private
insurance and Managed Care organizations as to billing for their
health care services they received at the Indian Health Service
( I H S ) facility.
Initiates pre-screening for all patients with no alternate resources
for potential eligibility under the Medicaid, Medicare, A H C C
S/County/State, A H C C S long Term Care, etcetera. Makes arrangements
for patient and family to complete the required application process
for these resources for which they may be eligible. Serves as an
advocate on behalf of the patient and family to accurately identify
and verify eligibility with these various resources. Also serves
as an advocate on behalf of the patient and family during an appeal
process if they are denied these resources. Assists in interpreting
services to individual/family conference and to provide education
information on any alternate resources, policy and procedures on
behalf of the Service Unit.
Interviews patients to obtain information to initiate a new health
record and communicates to Medical Records to reactivate a retired/stored
record. Enters all information into the R P M S Patient Registration
System and prints appropriate forms.
Performs other related duties as assigned.
Factor 1 - Knowledge Required by the Position:
Working knowledge of eligibility requirements of the Indian Health Services
program. Ability to apply a continuing awareness of constant revisions to
avoid negative ramifications of allowing a non-eligible individual seeking
medical care to enter the system, only to have to deny services after treatment
has begun, except in case of emergencies. Knowledge of whether documented
proof offered meets I H S requirements.
Knowledge of specialized medical terminology (for example, terms
of anatomy) used in determining nature of patient request for treatment.
Ability to lead/instruct/train others, and to reorganize workflow,
set priorities and determine best method to use to expedite the
work of the department. Knowledge in coordinating, planning, and
organizing assignments in order to make appropriate decisions on
a day-to-day basis according to priorities, needs and goals of
the department. Ability to train other employees.
Knowledge of basic supervisory techniques to manage activities
in the Patient Registration section. Knowledge of interpersonal
relations and skills to communicate in problem situations and report
findings. Possess current knowledge and ability to answer questions
of other employees on procedures, policies, directives, etcetera.
and obtain needed information or decisions from supervisor on problems
Knowledge of various clinical systems, walk-ins and appointments
to avoid unnecessary delays and/or confusion on the part of the
patient. Knowledge of the various services offered by each clinic
and forms used.
Knowledge of interviewing techniques, Managed Care services and
Billing functions, policies and procedures to be able to refer
inquires to appropriate personnel.
Knowledge of Privacy Act of 1974 and the use of confidential information
and health records as an integral part of the interviewing office
function and the privacy of individuals which must be protected
to the fullest extent possible.
Knowledge of the R P M S Patient Registration System, its function,
how to obtain appropriate information when needed and how to correct
errors and update and/or change demographic information.
Knowledge of and ability to use typing keyboard. A qualified typist
Able to interpret, in the Navajo language the non-English speaking
patients are able to comprehend important information on their
eligibility for direct care services, Contract Health Services
and other Alternate Resources.
Factor 2 - Supervisory Controls:
Work is performed under the general supervision of the Supervisory Health System
Specialist. The incumbent is fully responsible for administering the day-to-day
activities of the unit with some margin for independence in carrying out
responsibilities and following up on cases. The incumbent makes assignments
by providing overall task objectives, goals and priorities. Assists the Medical
Clerks with unusual situations which do not have clear precedents. The employee
plans, coordinates, carries out assignments and handles problems and deviations
in the work assignments using established policies and instructions. The
supervisor is generally available for making decisions in unusual situations
which do not have clear precedents or in cases when it is necessary for the
incumbent to have supervisory support.
Work is primarily reviewed in terms of the overall efficiency
of the services provided to patients, accuracy of the information
obtained and through the post review of “error listing” and
compliance with various guidelines. Reports from the R P M S Patient
Registration system captures monthly activities for third party
information and patient registration edits.
Factor 3 – Guidelines:
Written guidelines are found in the I H S manual, hospital circulars, technical
manuals, policy and procedures, H C F A directives, Medicare/Medicaid and
Contract Health Services regulations. However, these guides often do not
have adequate information to deal with unusual problems. Judgment is used
in locating and selecting the most appropriate guidelines, references and
procedures. If necessary, incumbent makes minor deviations to adapt the guidelines
to specific cases.
Factor 4 – Complexity:
Serving as the lead role, the incumbent performs a variety of functions. Distributes
and balances the workload among the other employees. Ensures that work assignments
of other employees in the unit are carried out. Instructs employees/answers
questions in specific task and job techniques. Works in various clinics (that
is, Ambulatory Care, Emergency Unit, Inpatient Unit (A / P / O B) satellite
clinics (that is, Ambulatory Care, Emergency Unit, Inpatient Unit A / P /
O B, satellite clinic Pueblo Pintado and Thoreau Clinic, Optometry, Dental,
New Horizon, specialty clinic and Triage). Registers patients, updates demographic
and third party information. Incumbent must be able to effectively communicate
to the patient what specific information is needed, the reason for requesting
such information, and be able to ascertain that it is accurate as possible.
Consequence of obtaining inaccurate information may delay necessary medical
treatment causing unnecessary frustration and problems. The work to be performed
and documents/forms utilized vary with each department. Decisions regarding
what needs to be done involves various choices that requires the employee
to recognize the existence of the difference among the duties to be assigned,
plus the process involved to complete the registration process.
Factor 5 - Scope and Effect:
The purpose of the work is to ensure the duties of the unit are identified,
distributed, and performed to accomplish the workload in a timely manner.
The work facilitates provision of complete and accurate Patient Registration
demographic and third party data for the hospital and/or clinic. Duties such
as the processing of authorized documents, courteous patient contact and
good public relations affect the ability of the facility to provide quality
patient care and program fund control.
Factor 6 - Personnel Contacts:
Personal contacts include coworkers, inpatients, outpatients, families, friends
of patients, hospital personnel, physicians, employees from contract health,
contracted billing, health records, clinical services, and administration.
Other contacts include insurers (Medicare, Medicaid, A H C C S, private insurance
companies, Managed Care organizations, etcetera) at the State, County and
Tribal level. Contacts are also with utilization review coordinators and
Factor 7 - Purpose of Contacts:
Contacts are for providing assignments to staff employees. Contacts with patients
are for obtaining insurance information, furnishing information of requested
changes by patients, exchanging nd providing factual medical information
to determine eligibility for services, length of stay authorized, and to
provide liaison services to providers and recipients.
Factor 8 - Physical Demand:
Work is mostly sedentary, with some walking, standing and bending while interviewing
patients and preparing the appropriate paperwork for treatment of a patient
or initiating a chart.
Factor 9 - Work Environment:
Work is normally performed in an office setting, which is adequately lighted,
heated and ventilated.
IV. OTHER SIGNIFICANT FACTORS:
Incumbent is required to work in various clinics ( that is, Ambulatory Care,
Emergency Unit, Inpatient Unit A/P/O B, satellite clinic Pueblo Pintado and
Clinic, Optometry, Dental, New Horizon, specialty clinic and Triage) on a
rotational shift on a (24) hour, (7) days a week, weekend shifts, Sunday
shift and holidays.