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Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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Area Standard Position Description 881290

(Collection Technician)

G S-540-05

This position is located in a Navajo Area I H S Service Unit, Division of Administration and Management, Business Office Branch. The primary purpose of this position is to perform a major segment of the accounts receivable support function through the follow-up process of all outstanding patient accounts within the Business Office

Reviews patient accounts to determine the status of the account, making standard adjustments that require special analysis and prepare and process a variety of documents necessary for the maintenance and follow-up of all outstanding patient accounts.

Performs work consisting of examination for accuracy, adequacy of documentation or citation, compliance with regulations, and justification of claims and other requests for payment for (1) services provided by the Government; (2) reimbursement of expenditures made by beneficiaries and non-beneficiaries for such purposes as medical care and treatment.

Review delinquent patient account records, following up with responsible parties via telephone and correspondence according to organization policy and procedures. Performs telephone contact with third party payers for amounts due. This function is performed on a timely basis, in accordance with hospital policy and procedures.

Maintains files system of patient accounts for follow-up with responsible parties on outstanding balances, makes financial arrangement in accordance with organizational policy and procedure. Referral to Contact Representative for interview process for qualification for other third party resources.

Generates contractual/adjustments documents when patient accounts require this function for resolution. Forwards documents to the Business Office Manager for approval on a daily basis.

Maintains documents of all activity related/performed on patient accounts in patient financial folder. Documentation will include dates, telephone numbers, name or person contacted with the status of payment.

Responsible for identifying patient accounts deemed non-collectable. Generates and maintains appropriate documents on such patient accounts and refers to Business Office Manager for disposition.

Prepares monthly, quarterly and annual reports utilizing the Accounts Receivable program. Reporting any discrepancies to the supervisor, providing all supporting documents and recommending resolution.

Factor 1 – Knowledge Required by the Position

Knowledge of total program, operation the priorities and goals of the Alternate Resources program. Keeps abreast of current changes in policy regulations on eligibility. Participates in planning, implementation, and improvement of the Accounts Receivable Program.

General knowledge of third party payer reimbursement logic and of the total accounts receivable management program. Excellent communication skills are required for interaction with the third party payer community.

Knowledge and understanding of established and standardized accounting procedures and techniques sufficient to handle duties assigned.

Knowledge of a variety of accounting transactions and documents, accounting symbolic codes, account structures, and procedures for setting up and crediting accounts receivables.

Knowledge of file systems to locate, adds, retrieve or correct routine information using well-established, clear cut procedures; and/or knowledge of accounting operations.

Knowledge of the established procedures, reimbursement formats, etcetera, associated with the various reimbursing third party payers.

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 I V 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.

Factor 2 – Supervisory Controls

The incumbent works under the supervision of the Business Office Manager. Supervision establishes general guidance and advice, and suggests techniques for handling unusual or nonrecurring situations, which have no clear precedents.

Incumbent plans and carries out the successive steps and handles problems and minor deviations in the work assignments in accordance with instructions and hospital policies and procedures.

Factor 3 – Guidelines

The incumbent to use judgement to identify and select the most appropriate procedure to use, choose from among several established alternatives, or decide which precedent action to follow as a model. There may be omissions to guidelines and the employee is expected to use some judgement and initiative to handle aspects of the work not completely covered. In locating, selecting and applying the most appropriate instructions, references, or procedures, the employee may make minor deviations in guidelines to adapt to specific cases. Will refer situations in which the existing guidelines cannot be applies or significant deviations must be made to the supervisor or designee.

Factor 4 – Complexity
The incumbent decides what needs to be done by identifying the nature of the problem, questions, or issue, and determining the need for and obtaining additional information through oral or written contacts or by reviewing regulations and manuals. The employee may have to consider previous actions and understand how these actions differ from or are similar to the issue at hand before deciding on an approach.

The voucher examiner process consists of duties that involve different and unrelated processes and methods. The complexity of the work involves working with remittances received from various programs, covering several states and third party payers who have different benefits and remittance formats.

Patient Account support consists of duties that involve different and unrelated processes and methods. The complexity of the work involves working with various programs, which cover different states, with each health insurance program having different benefits, deductible, and eligibility requirements.

Factor 5 – Scope and Effect
The incumbent applies specific rules, regulations, or procedure to perform a full range of related accounting and technical tasks, duties and assignments that are identified in Business Office third party collection process. Completes transactions by reviewing documents for missing information, searching records, and files; verifying and maintaining records of transactions; and answering routine procedural questions.

The incumbent assists in the posting of payments and contractuals/adjustments due for services rendered to Indian Beneficiaries and Non-Beneficiaries alike. The funds collected and posted are used 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 the funds collected.

Factor 6 – Personal Contacts
The incumbent has regular and recurring contact with employees within the hospital, local and state agencies, third party payers and Medicare and Medicaid fiscal intermediaries.

Factor 7 – Purpose of Contacts

The purpose of the personal contacts are to plan and coordinate the work of the cash posting function of the business office, resolution of problems pertaining to the posting of remittances and contractuals/adjustments to the patient receivable, and to resolve any unidentified remittances received for health care services rendered.

Factor 8 – Physical Demands
The work is primarily sedentary with the following physical requirements; Ability to lift up to 25 pounds, walk/stand for short periods of time as interaction between all disciplines within the facility is required, ability to stoop and pick up objects from the floor without restrictions, and have full use of hands and arms, that is, to operate office equipment such as computer, calculator, printer, fax, etcetera.

Factor 9 – Work Environment
All functions related to this position are normally performed in the business office setting.

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 be cause for adverse action.