|MEDICAL CLERK (O/A)
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:
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.
1. Knowledge Required By The Position.
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
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.
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.
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
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
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
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
Work is primarily sedentary with little physical exertion involved.
9. Work Environment
Work is normally performed in an office setting.
Position: MEDICAL CLERK, GS-679-04
Organizational Location: Contract Health Services Branch, IHS Service Unit
Standards Referenced: 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:
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:
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: Medical Clerk (O/A) GS-679-4
Vernon E. Hohmann
Position Classification Specialist
Indian Health Service
April 6, 1994