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Area Standard Position Description 881290
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
II. MAJOR DUTIES AND RESPONSIBILITIES:
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
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
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
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
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,
Factor 9 – Work Environment
All functions related to this position are normally performed
in the business office setting.
IV. OTHER SIGNIFICANT FACTS:
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.