MEDICAL CLERK (O/A)

GS-679-5

I. [Introduction]{.underline}:

This position is organizationally located in the Contract Health
Services (CHS) Branch,

Service Unit, Indian Health Service. The position affords support
services to the Supervisory Health System Specialist in providing a
viable CHS, alternate resources, and patient transportation program
which contributes to the direct health care assistance of eligible
American Indian/Alaska Native beneficiaries by non-Indian health care
providers. This position operates in compliance with regulatory
requirements from the Code of Federal Regulations at Title 42 of the
Indian Health Service.

II\. [Major Duties]{.underline}:

Initiates and distributes medical authorizations including both
hospitalizations and professional fees after determining patient
eligibility for CHS. Authorization documents must be thoroughly reviewed
for patient information, clinical data, obligation signatures,
certification signatures and fiscal data. Proper distribution and/or
routing is essential in the management of medical authorizations.
Determines eligibility of patients for direct and contract service.
Completes and maintains applications for medical care. Prepares denials
based on applicable CHS regulations, policies and practices. Utilizes
the CHS automated software system - CHS/MIS to enter medical and
financial data.

Contacts state agencies to determine medical eligibility within the
jurisdiction of the Service Unit; cross checks proposed authorizations
against sources prior to obligating the Service Unit for contract health
services. Functions in a liaison capacity to vendors (non- IHS
providers) and through written correspondence. Explains regulations and
policies to health service vendors and recipients as well as IHS
personnel.

Maintains document control registers for CHS funds allocated, which
requires the accurate accountability of funds and a comprehensive
knowledge of fiscal coding procedures. Records expenditures, subtracts
total amount from previous balance and establishes new current balances
(this is automatic in the CHS/MIS system). Provides informal reports on
the status of fund expenditures on a periodic basis. Prepares internal
financial analysis reports on each account maintained in the Service
Unit document control registers, including amounts currently budgeted,
obligated, and unobligated balances.

Reviews FI Apend@ lists and follows up on requirements for service unit
action.

Assists in maintaining a tracking system for high cost case management
of cases in order to document and request CHEF funds from IHS
Headquarters.

Maintains controls and makes arrangements for ambulance services subject
to the regulations regarding these purchases and the limitation of funds
authorized.

Prepares third party report forms for the recovery of the cost of
hospital and professional

services furnished to federal beneficiaries whose injuries resulted from
negligent third

persons.

Maintains files of elective procedures, prepares authorizations, and
schedules admissions in

CHS facilities when available. Maintains office files according to
established functional file systems involving the classification of
material into a large number of subject heading and subheadings.
Searches for and withdraws material when requested.

Screens and verifies all Contract Health Service notifications, invoices
of private vendors,

emergency room notes and patient discharge summaries to ensure that
medical services meet

medical priorities as a prerequisite to payment or denial.

Verifies that medical services are satisfactorily received and that
accurate payment or denial has been initiated.

Calculates estimated charges, prepares and issues appropriate purchase
orders or denials with

supporting medical justification, and issue referrals for individual air
transportation flights.

Obtains information via telephone or personal inquiries on the status of
patient billing; i.e.,

charges, payments, and outstanding balances.

Incumbent receives visits and telephone calls from hospital personnel,
patients and private

vendors. He/She will refer calls to the supervisor or the appropriate
personnel within

CHS. He/She will maintain at all time, professional telephone etiquette
in all contacts with hospital personnel, patients, and private vendors.

Incumbent will initiate and submit all mandatory correspondence and
reports to the supervisor in a timely manner. The maintenance of
documents will be in accordance with

the established file system and they will be maintained for historical
records by the

department.

Incumbent performs a variety of supportive tasks as assigned.

III\. [Factors]{.underline}:

1\. [Knowledge Required by the Position]{.underline}:

The position requires knowledge of basic and established procedures
related to routine

and repetitive aspects of CHS support work, i.e., the knowledge of:

\- basic terminology, forms, or reports that are part of a
transportation program to screen for missing information, prepare final
copy of documents, maintain files,

respond to routine questions, or perform similar duties,

\- understanding of ICD-9-CM and ability to do CPT coding work to
appropriate documents.

\- work flow of the unit sufficient to distribute messages and work to
appropriate personnel.

\- one or a few simple automated or manual transportation files to
locate, add, retrieve, or correct routine information using
well-established procedures.

Knowledge of basic accounting methods to assist with monthly reports.

Must have knowledge of Third Party Billing procedures, availability of
health resources and programs, rules of eligibility on medical
procedures, and must be familiar with medical terminology, medical care
practices and procedures.

Must have knowledge of the Catastrophic Health Emergency Fund (CHEF)
cases reporting.

Knowledge to monitor CHEF cases and assist in close out cases.

Must have knowledge of simple mathematical calculations used in
statistical reports for management.

Must have knowledge of personal or menu-driven computers, software and
output

(printer) equipment.

Must be able to type from a set format with a minimum of errors;
therefore a qualified typist is required.

2\. [Supervisory Controls]{.underline}:

The Supervisory Health System Specialist provides standing instructions
on recurring assignments by indicating what needs completion applicable
to operational policies and procedures, quality and quantity of work
expected, deadlines, and priority of assignments. Guidance may provide
information on how to:

\- screen documents for missing or incompatible information;

\- assemble and prepare forms or other paperwork that make up a file or
record;

\- use reports or other data to monitor the status of transactions;

\- use automated systems to access, retrieve, and generate various data
and reports.

The supervisor will provide additional, specific guidance and reference
sources on new or difficult assignments (i.e., those not covered by
standing instruction).

Employee uses initiative to perform recurring or individual assignments
independently. Employee refers situations not covered by initial
instructions to the supervisor for assistance.

Supervisor evaluates the accuracy and adequacy of individual assignments
by reviewing the frequency and nature of problems resulting from data
entry errors or problems with responding to inquiries or request. The
supervisor may also consider the nature and frequency of complaints,
review production reports, or use controls built into the systems.

3\. [Guidelines]{.underline}:

Procedures, i.e., format, preparation and arrangement of correspondence
and distribution of copies have been established. Specific guidelines,
i.e., agency or unit instructions, directives, notices, manuals or
technical dictionaries are available for reference.

The employee uses judgement in locating, selecting, and applying the
most appropriate alternative among the various guidelines covering
similar situations. Situations involving significant deviation from
established guidelines are referred to the supervisor.

4\. [Complexity]{.underline}:

The work involves performing related processing and procedural tasks in
support of transportation related functions.

Employee make decisions, i.e, how to sort incoming documents, locate and
assemble information, and correct errors. This is completed by reviewing
similar cases or standard operating procedures and selecting from among
clearly recognizable alternatives.

Employee takes action using established instructions, practices, or
precedents for format, content, and processing of CHS documents and
requests.

5\. [Scope and Effect]{.underline}:

The purpose of the work is to perform limited, repetitive, or closely
related tasks, i.e., sorting and distributing documents, entering
routine patient information into a data base system, and/or verifying
repetitive types of data.

6\. [Personal Contacts]{.underline}:

Contacts are with hospital employees in the immediate organizational
unit, with employees outside an organization, with members of the
general public and with patients who require the use of the
transportation systems and the Contract Health Services.

7\. [Purpose of Contacts]{.underline}:

The purpose of the contacts is to obtain, clarify, or provide
information related to daily support assignments, i.e., contacts may be
to obtain missing information, advise on the status of actions, or
verify information needs.

8\. [Physical Demands]{.underline}:

The work is sedentary, however may involve some walking, standing,
bending, and carrying light items, i.e., papers and books.

9\. [Work Environment]{.underline}:

The work is normally performed in an office setting and the work area is
adequately lighted, heated, and ventilated.

EVALUATION STATEMENT

[Position]{.underline}: MEDICAL CLERK (Office Automation), GS-679-5

[Organizational Location]{.underline}: Contract Health Services Branch,
IHS Service Unit

[References]{.underline}: USCSC, PCS, Medical Clerk Series, GS-679,
TS-30 Dated 4/78.

USOPM, PCS, Office Automation Clerical and Assistance Series, GS-326,
TA-100, Dated 11/90. USOPM, PCS, Office Automation Grade Evaluation
Guide, TS-100, Dated 11/90.

[Title and Series Determination]{.underline}:

This position requires the performance of Contract Health Services (CHS)
related duties, which involve a knowledge of third party billing
procedures, eligibility for CHS, medical terminology, and medical care
practices and procedures. Most importantly the position requires a
knowledge of basic and established Fiscal Intermediary procedures
related to routine and repetitive aspects of the CHS funds payment
program, which is an integral portion of the overall CHS program. The
position performs duties such as scheduling admissions or appointments.
Additional duties include determining eligibility of beneficiaries for
CHS, screening and verifying all CHS notifications, invoices of private
vendors; verifying that medical services have been received or payment
denial has been initiated; calculating estimated charges, preparing and
issuing purchase orders or denials; and serving as liaison between CHS
and major hospital programs, and private agencies. Subject position is
involved with administering the daily activities of the Service Unit\'s
patient transportation program, coordinating and arranging the transport
or escort of patients, preparing transportation schedules, completing
transport arrangements based on emergency. The balance of time is used
in performing miscellaneous clerical duties such as timekeeping,
contract health eligibility, verification of contract health services,
insuring payment and/or denials, receptionist duties, correspondence and
file maintenance and other supportive task. The GS-679 series includes
positions with primary duties which are to perform clerical work in
support of the care and treatment given to patients in a ward, clinic or
other such unit of a medical facility. The work requires a practical
knowledge of the medical facility\'s organization and services, the
basic rules and regulations governing visitors and patient treatment,
and a practical knowledge of the standard procedures, medical records,
and medical terminology of the unit supported. The work associated with
subject position is in support of the care given to patients through
utilization of contract health.

[Grade Level Determination]{.underline}:

Grading of subject position is accomplished by cross comparison
application of the cited administrative grade evaluation guide as
depicted on the attached FES evaluation, Office Automation Grade Level
Allocation is determined to be at the GS-3 Level.

[Conclusion]{.underline}: Medical Clerk (O/A) GS-679-5

/s/

Vernon E. Hohmann

Position Classification Specialist

Indian Health Service

April 6, 1994