MEDICAL CLERK (O/A)

GS-679-4

I. [Introduction]{.underline}:

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

Service Unit, Indian Health Service. The function of the CHS Branch is
to manage the contract health delivery program which provides health
care to American Indian/Alaskan Native patients through outside vendors
and contract providers. The purpose of this position is to provide
technical, administrative and clerical support to the CHS Branch in the
provision of Contract Health Service delivery.

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

Initiates medical authorizations to include hospitalization and
professional fees for eligible Indian patients. Maintains denial
correspondence files assuring that all appropriate documentation is
included in file.

Key enters information for automatic document control commitment
registers for the health services funds allotted, which requires
accurate accountability and a comprehensive knowledge of fiscal coding
procedures. Provides the supervisor informal reports on fund status
expenditures on a periodic basis.

Contacts state agencies and other outside organizations to determine
medical eligibility within the service unit jurisdiction. Cross compares
proposed authorizations with sources prior to obligating funds for
contract health services.

Provides CHS orientation to health service vendors, and recipients, as
well as service unit personnel, to insure that they possess a good
understanding of the program methods, policies, procedures and
regulation.

Conducts on-site patient interviews to establish eligibility and
completes and maintains application for medical care. Verifies records
of residence for applications by addressing inquiries to a variety of
sources.

Reviews incoming invoices to determine if authorizations have been
issued and if not, incumbent researches and takes appropriate action.

Verifies contract health eligibility for Indian patients using CHS
regulatory criteria and also determines patient eligibility for
third-party alternate resources.

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

Participates in CHS Review Committee meetings regarding approval for CHS
services.

Keys data into the CHS/MIS data system for issuing purchase orders.

Participates with the Health System Specialist in the development of
local CHS procedural guides, compiles and interprets various alternate
resource references and guides.

Provides support in the development and presentation of the local
preliminary and supplemental CHS budget.

Answers telephone and written inquiries regarding eligibility
requirements, payments, outstanding charges, and other questions
concerning the CHS Program. Maintains strict confidentiality in
responding to inquiries. Prepares routine correspondence and compiles
information for periodic special reports.

Types material from draft form using word processing automation.
Maintains appropriate files and performs other office clerical support
work as required.

Performs other related duties as assigned.

III\. [Factors]{.underline}

1\. [Knowledge Required By The Position.]{.underline}

Knowledge of CHS guidelines.

Knowledge of CHS Funds Control.

Knowledge of Service Unit programs as they interrelate to Contract
Health.

Knowledge of Office Automation equipment and procedures.

Knowledge of CHS Funding and basic record maintenance.

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

2\. [Supervisory Controls]{.underline}

Works under the supervision and direction of the Supervisory Health
System Specialist who assigns work in a general manner. The employee
executes routine assignments with a considerable degree of independence.
Most work is reviewed periodically for conformance to established policy
and procedure.

3\. [Guidelines]{.underline}

Guides include IHS directives and instructions on Contract Health
administration. Service Unit CHS procedures are also utilized. These
guides are somewhat general in nature and do not address all situations
specifically, requiring the incumbent to interpret and use individual
judgement in adapting these guides to specific situations.

4\. [Complexity]{.underline}

Work consists of numerous related procedural steps in preparing Contract
Health Services authorization documents. This includes determining
eligibility, availability of services and funds. The incumbent is
required to analyze many facets of the operation which increases
complexity of the work.

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

The purpose of the CHS Program is to provide eligible Indian patients
with medical care via contracts with outside vendors. Duties such as
timely management of CHS authorizations, eligibility determination and
funds control have a direct bearing on the ability of the service unit
to provide quality patient health care within allocated resources
available.

6\. [Personal Contacts]{.underline}

Contacts are with patients, families, service unit staff, Area Office
personnel, outside contractors and vendors, and third party alternate
resource organizations.

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

Contacts are primarily for exchanging information to determine
eligibility for service and for liaison activities with providers and
recipients. Contacts are also made for the purpose of orientation and
training activities.

8\. [Physical Demands]{.underline}

Work is primarily sedentary with little physical exertion involved.

9\. [Work Environment]{.underline}

Work is normally performed in an office setting.

EVALUATION STATEMENT

[Position]{.underline}: MEDICAL CLERK, GS-679-04

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

[Standards Referenced]{.underline}: OPM PCS Medical Clerk Series,
GS-679, 5 /78;

HHS Classification Guide for Contract Health positions 1/94; OPM Office
Automation, GS-326 Series 11/90.

[Title and Series Determination]{.underline}:

Subject position assignments involve technical, administrative, and
clerical support in the operation of a contract health services program
and dealing with third party alternate resource organizations in the
recovery of health care delivery funds. Such assignments meet the Series
definition of the cited GS-679 Series and are included within its
coverage.

[Grade Level Determination]{.underline}:

Grading is accomplished by direct application of Grade Level criteria
depicted in cited

GS-679 Standard. Grading of subject position is accomplished by cross
comparison application of the cited administrative grade evaluation
guide as depicted on the Factor Evaluation System evaluation, Office
Automation Grade Level Allocation is determined to be at the GS-3 Level.

(Note: supervisors may request the FES evaluation from
Headqurarters-CHS.)

[Conclusion]{.underline}: Medical Clerk (O/A) GS-679-4

/s/

Vernon E. Hohmann

Position Classification Specialist

Indian Health Service

April 6, 1994