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 BILLING TECHNICIAN
G S-503-7

I. INTRODUCTION
This position is located in the Tuba City Indian Medical Center, Division of Administration and Management, Business Office Branch. The primary purpose of this position is the overall responsibility for a major segment of the accounts receivable management function. This responsibility includes the submission of properly executed claims on a timely basis to third party payers and responsible patires and rebilling or corrected billing of accounts previously submitted.

II. MAJOR DUTIES AND RESPONSIBILITIES:
Supervises and assists in the timely and accurate submission of claims according to hospital policy and procedures. This includes submission of claims to third party payers, Medicare and Medicaid intermediaries and responsible parties.

Supervises and maintains follow-up procedure to secure approvals to bill Medicare and Medicaid claims on a timely basis.

Responsible for verification that all control functions assigned are maintained daily as set forth in hospital policy and procedures.

Documentation of all activity performed in the patient financial folder such as date billed and to whom.

Trains new employees and holds periodic in-house training sessions. Requires through cross training of employees to bill all types of coverage regardless of department origination.

Maintains diagnosis follow-up-procedures and working relationship with Medical Records Director and Medical Staff of hospital.

Maintains Daily billing Productivity Report that includes detail type of coverage and reason(s) for unbilled claims. Submits a weekly summary to Business Office Manager.

Reviews all rejected/suspended claims to determine reason(s) for rejections/suspension and delegates back to appropriate biller for correction and resubmission.

Supervises handling of inquires from third parties and patients regarding claims and ascertains they are addressed correctly and timely.

In accordance with hospital policy and procedures, position is responsible for the correction all claims returned by a third payer.

III. FACTORS:
Factor 1 – Program Scope and Effect
The incumbent is responsible for the supervision of this billing function for services rendered to beneficiaries and non-beneficiaries alike. This responsibility includes the submission of properly executed claims on a timely basis to third party payers and responsible parties and rebilling or corrected billing of accounts previously submitted. The quality of this process directly impact the speed at which reimbursement is received for services rendered to the beneficiary and non-beneficiary alike. 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
This position is accountable to the Business Office Manager who reports directly to the Administrative Officer.

This responsibility includes the overall supervision of all activities related to the submission of claims for services rendered to all patients receiving services from the facility.

Factor 3 – Supervisory and Managerial Authority Exercised
Plan work to be accomplished by subordinates, set and adjust short-term priorities, and prepare schedules for completion of work;

Assign work to subordinates based on priorities, selective consideration of the difficulty and requirements of assignments, and the capabilities of employees;

Track progress and quality of performance; evaluate work performance of subordinates;

Give advice, counsel, or instruction to employees on both work and administrative matters;

Interview candidates for positions in the unit, recommend appointment, promotion, or reassignment to such positions;

Hear and resolve complaints from employees, referring group grievances and more serious unresolved complaints to a higher level supervisor or manager;

Effect minor disciplinary measures, such as warnings and reprimands, recommending other action in more serious cases;

Identify developmental and training needs of employees, providing or arranging for needed development and training;

The incumbent utilizes a number of substantive guidelines. Guidelines are provided and include the following: IHS circulars, Medicare and Medicaid newsletters and bulletins, State, Federal and Public laws, I H S procedure manuals. Applicable technical references are available from the private sector.

Factor 4 – Nature of Contacts
The incumbent has regular and recurring contact with personnel within the facility, local and state agencies, third party payers, Medicare and Medicaid fiscal intermediaries. Contacts may also include the general public and the patient population of the facility.

The purpose of the personal contacts is to plan and coordinate the work of the all functions the incumbent is responsible for. Additional purpose for contacts may be to exchange information for clinical for financial purposes in an effort to obtain reimbursement for services rendered to beneficiaries and non-beneficiaries alike.

Factor 5 – Difficulty of Typical Work Directed
The primary purpose of this position is to overall responsibility for a major segment of the accounts receivable management function. This responsibility includes supervising the submission of properly executed claims on a timely basis to third party payers and responsible parties and rebilling or corrected billing of accounts previously submitted.

The position supervises four (4) Billing Technicians (Office Automation), G S-603-6; two (2) Accounting Technician, G S-525-4/5; and two (2) Voucher Examiners, G S-540-4/5.

Factor 6 – Other Conditions
Knowledge and understanding of established and standardized business office procedures and hospital policies sufficient to handle duties such as listed in section II, Major Duties and Responsibilities, of this position description.

Through knowledge of Medicare, Medicaid and third party payer regulations and how to work within their guidelines. Attendance at special workshops and training sessions in Medicare, Medicaid, and other third party payers assists in staying current on changing regulations.

Working knowledge of I C D-9-C M and C P T/H C P C S coding terms in order to interpret and resolve problems based on information derived from system monitoring reports and the U B 92 and H C F A -1500 billing form submitted to the third party payer.

Through knowledge of third party claims submission processes. Attendance at special workshops and training sessions in Medicare, Medicaid and other third party payers assists in staying current on changing regulations. Excellent communication skills are required for training of staff on changes through continuing education.

Ability to establish and maintain relationships with the third party payer community necessary for resolution of disputed claims.

Knowledge of the on-line input terminal equipment and automated electronic billing system(s) established procedures, formats, etc., associated with the various third party payers.

Excellent communication skills are required for training of staff on changes through continuing education.

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 ruling, 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 various third party payers and intermediaries.

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

Knowledge of and the ability to apply the Alternate Resources regulations; P. L. 94-437, Title IV of Indian Health Care Improvement Act, Indian Health Service Policy and Regulations on Alternate Resources, C F R 42-36.21 (A) and 23 (F), and P. L. 99-272, Federal Medical Care Cost Recovery Act.

The work is primarily sedentary requiring some bending, walking, standing and carrying of patient records and light supplies, No unusual physical demands are required.

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 his/her attention or knowledge. The Privacy Act carries both civil and criminal penalties for unlawful disclosure of records. Violations of such confidentiality shall cause for adverse action.