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SUPERVISORY HEALTH SYSTEMS SPECIALIST
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.
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
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
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
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
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
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
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
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.