MEDICAL CLERK (O/A)/MEDICAL ASSISTANT

GS-679-06

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 a CHS Delivery System. The purpose of this position is to
provide support and technical assistance to specialists in the provision
of Contract Health care to Indian beneficiaries.

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

Determines patient eligibility for care under the Contract Health
Service Program. Applies CHS rules and regulations on CHS Delivery
Areas, geographical facility proximity, tribal membership, and
residence. Determines patient eligibility as a prerequisite to the
authorization of funds. Participates in the decision-making process for
the provision or denial of payment for services based upon eligibility
criteria.

Defines alternate resources available to patients under the CHS Program
and determines patient eligibility for Medicare, Medicaid, Vocational
rehabilitation, V.A., private insurance or other third parties. Contacts
alternate resource agency or organization via telephone, correspondence
or personal visit to insure maximum utilization. Conducts personal
interviews with patient or family members to determine potential
eligibility for alternate resources.

Assists with the reporting of Catastrophic Health Emergency Fund (CHEF)
cases. Works closely with Service Unit CHS staff, Medical Officers, and
Area CHS office to report, manage, and monitor the high cost cases
funded through the CHEF program as established by P.L. 100-713, Section
202. Ensures timely close out of CHEF cases and provide periodic site
visit to Service Units to assist the CHS staff.

Makes patient transportation arrangements subject to regulations
regarding purchases and the limitation of authorized funds. Insures that
authorizations processed comply with established priority for services.

Administers day to day activities required of the CHS Program by
initiating CHS medical purchase orders. Performs periodic reviews and
audits of purchase orders for conformity to policy and regulations.

Insures consistency and correct use of document coding required by Area
financial management policy. Assures that the issuance of the purchase
orders to providers are within specified time limits. Reviews purchase
orders to insure correct and complete documentation.

Works with the Service Unit professional and para professional staff in
providing appropriate data for Service Unit contract requirements for
physician, hospital, dental, laboratory, radiology, ambulance and other
health services for the determination of reasonableness of rates by
outside contractors and vendors.

Maintains CHS automated commitment register in the RPMS to insure the
accurate accountability of funds and proper fiscal coding procedures.
Posts allotments and obligations to proper accounts and establishes
current balances on a daily basis making adjustments as required.
Performs reconciliation of CHS Management Information System and
financial health accounting system reports.

Maintains denial correspondence files including supporting documentation
and insures that reconsideration requests are made available to the
appropriate supervisor in a timely manner. Ensures that FI Apends@ for
service unit action are resolved in a timely manner.

Maintains monthly and special reports including the CHS Managed Care
Patient Status Report to the CHS Committee. Types letters and memoranda
for forwarding to the Area Office or other offices.

Works with the IHS fiscal intermediary to resolve payment problems and
coordinate alternate resource benefits. Provides information via
telephone, or written communication on personal inquiries regarding such
matters as payment of outstanding charges or eligibility questions.
Insures the maintenance of strict confidentiality in the processing of
all inquiries. Prepares responses to routine correspondence and compiles
information concerning contract services for submission to patients,
Area Office and Service Unit Administration.

Participates in the CHS Review Committee meetings.

Performs other related duties as assigned.

III\. [Factors]{.underline}:

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

Detailed knowledge of CHS procedures and regulations governing
eligibility determination.

Working knowledge of funding limitations and policies.

Extensive knowledge of CHS Programs as related technical, administrative
and clerical functions. Must have knowledge of the Catastrophic Health
Emergency Fund (CHEF) cases reporting. Knowledge to monitor CHEF cases
and assist in close out of cases.

Ability to type proficiently using knowledge of word processor,
software, electronic or automatic typewriter, and other office automated
equipment and calculators.

Knowledge of grammar, spelling, punctuation, formats, office procedural
manual, correspondence files, appropriate agency and medical
terminology.

Knowledge of proper processing requirements including forms,
authorization documents and standard correspondence.

Knowledge of various accounting systems including commitment registers.

Practical knowledge of specialized medical terminology.

Knowledge of Privacy and confidentiality considerations.

Ability to communicate both orally, in writing or in person.

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

The supervisor provides direction by defining objectives and priorities
and provides assistance on special assignments. Incumbent plans and
executes work assignments in accordance with established procedures,
policies and regulations. Completed work is reviewed for
appropriateness, soundness, and conformance to policy and other
requirements.

3\. [Guidelines]{.underline}:

Guides available include Indian Health CHS Manual, FI Manual, policy
issuances and directives and clerical procedural manuals. The incumbent
follows specific instructions but frequently exercises initiative and
judgement in making individual determinations within the parameters of
established guidelines.

4\. [Complexity]{.underline}:

The work involves identifying and processing a wide variety of
transactions involving multiple interrelated steps. The incumbent must
decide at each stage what impact a decision will have on subsequent
steps in terms of compliance with regulatory compliance as well as
achievement of the appropriate objective.

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

The function of the CHS Program is to provide eligible Indian patients,
in accordance with established priorities, medical care through both
direct and contract means for services. The duties of this position,
such as the timely processing of authorization documents, accurate, and
courteous dealing directly affect the ability of the service unit to
provide quality health care and program fund control.

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

Contacts are with service unit profession and para-professional
employees, outside contractors and vendors, third party alternate
resource organizations regulatory agencies patients and their families.

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

Contacts are made for the purpose of exchanging information, resolution
of problems, providing guidance and arranging meetings.

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

Work requires some walking, standing, bending and carrying light objects
such as papers or books.

9\. [Work Environment]{.underline}

Work is generally performed in an office setting.

EVALUATION STATEMENT

[Position]{.underline}: MEDICAL CLERK (O/A), GS-679-06

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

[References]{.underline}: HHS/PHS/IHS Classification Guide Contract
Health Services, Part II, 1/94;

OPM PCS, Medical Clerk, GS-679, Series, 5/78; OPM PCS Office Automation
Clerical Assistant, GS-326, Series 11/90.

[Title/Series Determination]{.underline}:

Subject position provides technical, automation and clerical support in
the day to day operation of a field contract health services (CHS)
program. Responsible for reviewing CHS applications from Indian patients
for determination of eligibility for CHS health care. Other major
assignments involve dealing with third party alternate resource
organizations in recovery of health delivery funds. Such assignments
meet the series definition and are included in coverage in the cited
GS-671 standard and in accordance with instructions are titled Health
System Specialist. Office Automation is parenthetically added to denote
the requirement for a proficient typist skilled in the use of Automated
Office equipment.

[Grade Level Determination]{.underline}:

Grading of subject position is accomplished by direct application of the
FES grading criteria published in the cited GS-671 standard as depicted
on the attached FES evaluation.

[Conclusion]{.underline}: Medical Assistant (O/A), GS-679-6

/s/

Vernon E. Hohmann

Position Classification Specialist

April 6, 1994