U.S. Department of Health and Human Services
Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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Business Office Enhancement
 
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SUPERVISORY HEALTH SYSTEMS SPECIALIST
(Patient Registration)

G S-671-07

I. INTRODUCTION:

This position is located in the Facility Business Office (F B O) at the Kayenta Health Center, Kayenta, Arizona. The Service Unit includes one clinic at Inscription House. The Service Unit covers to 3,600 square miles with the health center located seventy (70) miles from the hospital. The functions of the F B O is to ensure an efficient and timely system of billing and collection of health care resources, patient registration eligibility determination, resource patient management, training and managed Contract Health services and fiscal accountability.

The purpose of this position is to serve as the first level supervisor and to provide support and technical assistance to the Service Unit management by evaluating, analyzing and coordinating the operations of the Patient Registration Admissions office. The incumbent will also provide technical assistance to the Business Office Manager and the Chief Executive Officer on matters involving Patient Registration.

II. MAJOR DUTIES AND RESPONSIBILITIES:
Supervisory Responsibilities: 60%
Serves as the Supervisory Health Systems specialist with responsibility for coordinating and distributing workload; supervises the Patient Registration staff consisting of six permanent Medical Clerks (O A), G S-679-04. Reviews the workload and progress of the office; has the authority to accept, reject, or amend competed assignments based on established standards and instructions. The incumbent allocates work assignments, coordinate work efforts, resolve operating and administrative problems, review and evaluate work efforts. The work required is also judgmental in that the incumbent must consider possible entitlement to the Business office programs and the most advantageous way of processing the action or making further research to entitlement to all reimbursement activities. Information and circumstances vary based upon the multiple programs with complex entitlement provisions and the varying degree of comprehension of the Patient Registration/Admissions Office and alternate resources requirements and policies.

Trains, develops and orientates subordinates, Interprets regulations, requirements and procedures. Provides explanation on the inter-relationship of the various facts of the Business Office operations, Medical Records Department and Contract Health Service; activities and functions related to specific review of performance evaluation for these employees. Approves and disapproves annual and sick leave based on workload.

Establishes and maintains production control; assures that internal reports are maintained for use in evaluating quantity and quality of employee production. Maintains records of work accomplishments and time expends, preparing workload and production reports as required, that is, monthly reports, patient registration exports, and Data Processing Service reports.

Technical Duties: 40%
Interviews patients to obtain pertinent patient registration information, assist patient in completing new or update forms for the Resource Patient Management System (R P M S), determines the eligibility of patients in accordance with I H S and Navajo Area guidelines, identifies patients whose health benefits are subject to prior approval, obtains and verifies all alternate resource data necessary for patient registration and billing.

Ensures that all patient demographics and third party resource data is updated and accurate so that when information is exported to Navajo Area Office, third party reimbursements are not hindered.

Makes final determinations on direct care eligibility of all individuals seeking care who have not previously established eligibility and of those individuals who have been treated previously and eligibility is now in question. Determines whether patient care falls within scope of the I H S Program. Requests documentary proof of eligibility when necessary. Exercises delegated authority to make a preliminary determination in cases of questionable eligibility.

III. FACTORS:
Factor 1 – Program Scope and Effect:
Scope: The incumbent supervises and directs the Patient Registration Department. The purpose of work is to provide complete and accurate patient data for K H C. The processing of authorized documents, courteous patient contacts and good public relations affect the ability of the facility to provide quality patient care and service as the first step in the Third Party Reimbursement segment of the Business Office.

Effect: The direct effect on medical service reimbursement promotes services and provides to program funding of the entire service unit.

Factor 2 - Organizational Setting:
The incumbent is under the direct supervision of the Business Office Manager who sets the overall objectives and resources available for the Business Office Component. Incumbent works with relative independence in the conduct of the program, requiring only occasional consultation with the supervisor for guidance in the technical or policy areas. The incumbent must also make programmatic decisions that may have ramifications on other programs, such as Medical records and Third Party Billing; decisions must be accurate regarding the validity of patient data and eligibility in order to expedite medical treatment and proper billing procedures. Judgment is used in locating and selecting the most appropriate guidelines, references, and procedures in the decision-making process. Incumbent must be able to make deviations and adapt written and established guidelines to specific situations and cases. Guidance from the supervisor is received on new or changed internal procedures, with work being reviewed for overall efficiency of the services provided to patients, accuracy of patient information and compliance to established guidelines. The Business Office Manager reports to the Administrative Officer, who reports to the Chief Executive Officer, and the Chief Executive Officer reports to the Navajo Area Director.

Factor 3 – Supervisory and Managerial Authority Exercised:
Incumbent exercises delegated authority to:

Supervises and monitors subordinates in the performance of patient registration and patient admission activities. Makes work assignments to subordinates, adjusting workload to meet patient load, special projects, E T. Provides technical assistance to management, medical providers, patients, and other facility personnel regarding the work of the program. Evaluated programmatic problems/concerns relative to the operation of the department, solves/resolves current problems, or provides recommendations to supervisor. Coordinates work efforts with other department. Responsible for providing various monthly reports, for example, patient registration exports and Data Processing Service Reports. Trains new employees in all aspects of the work in the department, personnel regulations, organization, job techniques. Makes available and explains written instructions, reference materials. Approves all types of leave, keeps employees informed of management goals and objectives. Establishes, monitors, and evaluates performance of the work group, determines training needs, recommendations for promotions, W I G I's incentive awards and other personnel actions. Resolves and takes actions regarding grievances conduct and performance problems. Counsel’s employees regarding leave performance, discipline and conduct. Responsible for furthering E E O by demonstrating fairness in making all personnel decisions, encouraging and recognizing the achievements of subordinates, fair treatment of minority employees, sensitive to the development needs of all employees, and full utilization of employee skills. Displays initiative in promoting suggestions to improve the overall operations and enhance cost containment’s initiatives.

Factor 4 - Personal Contacts:
Contacts are with patients, their families, hospital personnel, general public, and health provider’s from outside the facility. Contacts may also be with accrediting agencies, state and federal agencies and third party carriers.

Purpose of Contacts – Contacts are for the purpose of obtaining, furnishing, exchanging and providing factual medical information to determine eligibility for services, and to provide liaison to providers and patients. Must coordinate work efforts and resolve problems involving other departments, such as other facets of the Business Office operations, Medical Records Department and contract Health Services.

Factor 5 - Difficulty of Typical work Directed:
Incumbent supervises and directs the work of six (6) Medical Clerks (O A) G S-679-4, who are responsible for obtaining and maintaining accurate and up to date patient demographics information and accurate medical information, which includes Medicare/Medicaid insurance, and private insurance information and their validation. Incumbent has the final technical authority for the work directed. The supervisor provides administrative supervision, allowing the incumbent to function independently regarding technical matters of the work unit.

Incumbent conducts staff meetings and conferences with staff to explain work requirements, methods and procedures as needed, giving special instruction for difficult or complex activities and answer technical questions about work assignment.

Factor 6 – Other Conditions:
The incumbent will actively participate in providing education to the service population regarding the Indian Health Service and the Kayenta Health Center Facility’s mission and service availability to the community.

The position requires that incumbent posse knowledge of overall Business Offices functions, policies, procedures, etcetera, in order to coordinate and interface patient registration and admissions within the total scope of the Business Office Program and have knowledge of interviewing techniques.

Work is normally performed in an office setting, which is adequately lighted, heated, and ventilated.

Incumbent is required to work on a rotational basis for shift, weekends or holiday duty.

Knowledge of the theory and principles of management and the organization, including administrative practices and procedures common to the Health Care Delivery Systems.

Knowledge of I H S and K S U mission and health care programs and how health care is coordinated and integrated with Patient Registration/Admissions.

Knowledge of third party and alternate health care progress, the various programs and eligibility requirement to assure maximum utilization of third party reimbursement.

Knowledge of I H S and private healthcare management and clinical services to operate and coordinate Patient Registration/Admissions, Contract Health Services and Third Party Billing Programs.

Knowledge of I H S automated data processing system.

Knowledge of supervisory methods and procedures.

Knowledge of I C D-C M and C P T-4 coding.

E E O Statement: Within the jurisdiction of the immediate organization unit supervised, the incumbent is responsible for the application and implementation of E E O Program guidelines and the achievement of tangible E E O progress and results relative to minorities and women. Sets the tone through, and carries out the leadership roles by initiating affirmative E E O action in selection details, reassignments, training, awards, career ladders, and/or lattices, hiring, redesigning jobs, developing model in E E O matters for the benefit of subordinate supervisors and employees. Seeks out and utilizes all available resources in carry8ing out E E O responsibilities i.e., the appropriate personnel generalist, E E O duties and/or counselors, applicable training resources, etcetera. Reports will be submitted in regard to E E O matters as required.