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Supervisory Medical Clerk
(Patient Registration Section)

G S-679-08

INTRODUCTION:
The position is located in the Business Office Branch, Patient Registration Section of the Gallup Indian Medical Center (G I M C), a 98 bed, referral, general medical and surgical hospital. The position evaluates, analyzes, coordinates and supervises the operations of the Patient Registration Section, which consist of the Patient Registration Unit, Pre-Certification Unit and Admissions Unit.

MAJOR DUTIES AND RESPONSIBILITIES:
Supervisory Duties:
Directs the operation of the Patient Registration Section according to hospital policy and procedures. This includes providing technical assistance to management, medical providers, patients and other facility personnel regarding the work of the Business Office Branch.

Supervises (1) Lead Medical Clerk G S-06 and (22) Medical Clerks G S-05 by assigning daily work schedule, recommending the approval of leave, rating performance and other administrative actions with the Business Office Manager.

Verifies all control functions assigned and assures that they are maintained daily, as set forth in hospital policy and procedures. Supervise employee reporting areas, to ensure appropriate staffing by function.

Responsible for development and implementation of a pre-registration program with the assistance of the Business Office Manager, Medical staff and surgery departments.

Responsible for work assignments, ensuring coverage in all registration and admission locations. Adjusts workload to meet patient load and/or special projects, etcetera.

Responsible for approval of annual and sick leave requests based on workloads.

Trains new employees and holds periodic in-house training sessions. Interprets regulations, requirements and procedures. Provides explanation on the inter-relationships of various functions of the Business Office operation, Medical Records Department and Contract Health Services.

Reviews monthly random sampling of the department’s production for quality to determine training needs of staff.

Maintains a working relationship with the Business Office, Medical Records and Medical staff of hospital.

Monitors the creation, maintenance and distribution of all required documents and statistical reports related to patient information.

Establishes and maintains productivity controls and goals. Implements internal reports for use in evaluating quantity and quality of employee production. Prepares workload and production reports as required by management.

Interviews patient or guarantor to obtain identifying and biographical information. Interprets hospital regulations to patients. Communicates rates, charges services discounts, and hospital policy regarding payment of bills.

Oversees patient eligibility determination in accordance with I H S and Navajo Area guidelines. Supervises the verification of benefits and identification of those patients whose health benefits require prior approval and processing.

Makes rounds through all reporting areas daily.

As required, solicits assistance of the Business Office Manager in difficult to resolve situations.

The incumbent utilizes a number of substantive guidelines. Judgement is used in locating and selecting the most appropriate guideline, reference and/or procedure for application, and when making minor deviations to adapt guideline to specific cases.

Technical Duties:
Provides supervision and direction to a variety of technical admissions, discharge and transfer functions such as, compiling medical statistics and reports. Performs daily inpatient census, admits hospital patients, obtains and processes demographic and third party information for: Alternate Resources, Contract Health Services and commercial insurance. Provides training to hospital staff regarding admissions, discharges and transfer of patients via the R P M S system, retrieving and compiling medical record data.

Serves as Admission, Discharge and Transfer (A D T) Technician and A D T Coordinator for the Branch. As such, responds to physicians, nurses, the center’s A D T Coordinator, patients, their authorized representative(s), and third parties such as, Business Office Personnel, the State’s Peer Review Organization (P R O), Health Care Finance Administration (H C F A), Joint Commission on the Accreditation of Health Care Organizations (J C A H O), insurance companies, Social Security Administration, Veteran’s Administration, and other state and government agencies.

The incumbent:

  • Initiates all admitting forms to complete the admissions process, including the “Patient Advance Directive” and interviewing mothers of newborn. Initiates patient identification bands for all admissions.
  • Initiates daily-automated census with ward clerks and compiles daily, monthly, quarterly and yearly statistical reports for managerial usage.
  • Interviews patients to obtain pertinent patient registration information, that is, demographic, insurance information and authorization to enable the Business Office to bill for health services provided from all alternate resources, including the non-beneficiary services.
  • Obtains signatures on required forms for alternate resources and contract health services, prior to patient being seen in the clinics, for billing purposes and/or contract health services eligibility.
  • Coordinates the A D T activities for the Business Office with the Nursing A D T Coordinator. Resolves all A D T problems and provides needed A D T Training to G I M C staff members.
  • Maintains inpatient/outpatient valuables according to policy and procedures. Acts as Collections agent, maintaining daily and monthly inventory of deposited patient valuables. Resolves all problems and provides needed Patient Valuables training to G I M C staff members.

Collects and obtains photocopies of third party recipient health cards. Explains program to the beneficiaries, that is, why Medicare/Medicaid and/or Private/Commercial insurance will be billed for the services rendered at G I M C.

Assists patients in completing new or updated forms for the R P M S Patient Registration System. This will include inpatients, outpatients, emergencies and after-hour patients. Determines the eligibility of patients seeking health care, by obtaining the Certificate of Indian Blood or other documentary proof or tribal membership, according to I H S guidelines.

Decides on the methods to use to achieve work goals and objectives in conjunction with and Business Office Manager.

Performs other related duties as assigned.

Factor 1 – Program Scope and Effect:
The incumbent supervises and assists in the patient registration and admission process of Indian beneficiaries and non-beneficiaries, prior to the rendering of patient medical services. The quality of each of these processes directly impact the speed at which reimbursement is received for services rendered to beneficiaries/non-beneficiaries. The funds collected by the Service Unit and Area Office, programs for projects and planning purposes, which aid the overall objective of elevating the health status of Indian beneficiaries. The successful efforts of the incumbent directly impact those funds collected.

Factor 2 – Organizational Setting:
The incumbent works under the general supervision of the Business Office Manager, who establishes general guidance and advice, and suggests techniques for handling unusual or non-recurring situations which have no clear precedents. Incumbent independently plans and carries out assignments, handles problems and makes minor deviations, in accordance with instructions and hospital policies and procedures.

Factor 3 – Supervisory and Managerial Authority Exercised:
The incumbent has been delegated basic supervisory authorities and exercises the following responsibilities.

  • Plans work to be accomplished by subordinates, sets and adjusts short-term priorities, and reviews completion of work. Assures that production and accuracy requirements are met.
  • Assigns work based on priorities, difficulty and requirements of assignments and work capabilities of employees
  • Evaluates work performance of subordinates.
  • Gives advice, counsel, and instructions to employees regarding work and administrative matters,
  • Hears and resolves complaints from employees, referring grievances and more serious unresolved complaints to the Business Office Manager.
  • Identifies training and developmental needs of subordinates, providing or arranging for needed training.
  • Communicates and coordinates the Patient Registration/Admission Program with hospital, departments and staff.
  • Finalizes monthly/yearly workload statistical/CQI reports in conjunction with the Business Office Manager.

Factor 4 – Personal Contacts:
The incumbent has regular and recurring contacts with Business Office staff, other hospital departments, nursing supervisors, medical staff, patients, local and state agencies, third-party payers, Medicare and Medicaid fiscal intermediaries. Contacts are formal and informal and occur in person at the work site, in routine meetings, or by telephone.

The purpose of contact is to plan and coordinate the work of the registration/admission department for services rendered to Indian beneficiaries and non-beneficiaries like. Contacts are also made to obtain patient information and required documents, or exchange information to obtain maximum continuity of care, alternate resource benefit utilization for patient, and to facilitate utilization of health services. Contact with nursing and third party payers are to enhance medicolegal and reimburse information. Contact with the supervisor is to insure all legalities and concerns are met, that is, subpoenas and Advance Directives. The incumbent must be able to satisfactorily explain complex rules and requirements to evoke cooperation from individuals who may have little concern on how the matter is resolved, or are not able to accept or understand instructions.

Factor 5 – Difficulty of Typical Work Directed:
Incumbent supervises (1) Lead Medical Clerk (O A) G S-679-06, and (22) Medical Clerk (O A G S-679-05. Position performs direct line authority, administrative and technical responsibilities over the Patient Registration Section. Work frequently involves establishing patient registration/admission processes, handling irate or distressed patients, working with medical/nursing staff members and assisting in settling controversial issues. The complexity of the work involves interaction with various programs covering several states and third party payers who have different benefits and remittance formats. Position determines how the registration/admission functions should be performed in accordance with available guidelines and instructions, and directs staff accordingly.

Factor 6 – Other Conditions:
Conditions that contribute to the difficulty and complexity of the position are - carrying out responsibilities of direct line authorities, patient registration technical functions, administrative/managerial functions, scheduling and coordinating the sections shift work. The incumbent insures that the technical and clerical completion of assignments meet accreditation, state and federal law, and reimbursement standards. Employee turnover and constant training further complicate the responsibilities.

Other Significant Facts:
Knowledge Required:

Knowledge of the Resource Patient Management System (R P M S) and the accounts receivable management program. Keeps abreast of current changes in government regulations, collection laws, F T C rulings, third party payer procedures and internal procedures.

Ability to establish and maintain relationships with the third party payer community necessary for verification and pre-certification processes.

Knowledge of the on-line eligibility systems and their equipment, established procedures, formats, etcetera., associated with the various third party payers and intermediaries.

Knowledge of automated systems, ability to type, and operate a calculator.

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 their 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.

The incumbent is required to be available for on-call duty, as scheduled.