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ACCOUNTING TECHNICIAN 213400
G S-525-06
I. INTRODUCTION:
This position is located in the Business Office Services Branch
of the Chinle Comprehensive Health Care Facility. The position
performs accounts receivable support functions for the patient
account system, through the posting of payments and adjustments
to accounts receivable in the Patient Accounts Section.
II. MAJOR DUTIES AND RESPONSIBLITIES:
10% Maintains accounts by reviewing documents to verify accounting
data as necessary, entering data into the system. They reconcile
accounts comparing account balances with related data to assure
agreement; reviewing records and source documents to identify the
sources of discrepancies; and determining the entries required
to bring the account to balance. Prepare reports reflecting the
examinations made, discrepancies noted, and the corrective entries
required adjusting accounts.
10% Examine accounts or resolve difficult reconciliation requiring
an analysis of adjustments and corrective entries in the patient
account system. Trace transactions entered and prepare and/or provide
supporting documents reflecting the source of discrepancies, corrective
action required to bring accounts into agreement, prove the accuracy
of adjusted accounts, and recommend actions to prevent recurrence
of similar discrepancies.
5% Performs work consisting of examination for accuracy of claims
and other request 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.
5% Maintains the automated accounts receivable ledger associated
with third party payer claims. Responsible for associated records
and documentation. Reviews and reconciles all third party payer
documents for correct data, on all third party vouchers for accurate
claim numbers.
5% Prepares all pertinent documents for refunds to payers, this
process involves direct communication with payers and Navajo Area
Finance. All refunds under $500 dollars are processed here at the
Service Unit Level. Public Vouchers are initiated and processed,
the Administrative Resource Management System is utilized in making
sure payment has been processed.
5% Prepares monthly, quarterly and annual reconciliation and recapitulation
of third party billing to assure that collections, billed data,
and the computerized and manual reports are in balance.
5% Prepares monthly reports: Upload Third Party Bills by Approval
Data(s), this process ensures that duplicate bills are not crossed
over to the Accounts Receivable program. The Bill File Error Scan,
this process is used to compare the billing file against the Accounts
Receivable file making sure that there are no errors setting in
the edit mode of Third Party Billing. Third Party Reload by Date,
this process is used to correct any discrepancies noted as a result
of the Bilstal File Error Scan. These reports are vital to the
Accounts Receivable process.
10% Reviews and examines various bill types, of patient care to
third party payers and performs third party collection posting
to the automated account receivable program. Receives and reviews
all Explanation of Benefit and remittance from third party payer.
Identifies and records proper claims numbers on each remittance
and post to the appropriate account.
10% Responsible for the posting of all contractual/adjustments
related to and in conjunction with posting of payments in accordance
with hospital policy and procedures. Monitor accounts balances,
review posting to ensure accuracy and recommend appropriate corrective
action.
10% Audits all documents received for completeness and accuracy;
analyze and select guide to determine whether payments are full
or partial in accordance with hospital policy and procedures; whether
they are timely; and whether remittance are advances, installments,
or supplements.
5% Responsible for accurate processing of secondary and tertiary
billing after posting payment of initial claims.
5% Maintains current documentation and guidelines pertaining to
reimbursement activities in appropriate files, binders, etc., and
ensures preparation and distribution of copies to all appropriate
disciplines.
5% Maintains Electronic Data Interchange (E D I ) applications
for automated posting into R P M S Accounts Receivable. Initiates
file transfer of A N S I x 12 835 file (electronic Remittance Advice & Explanation
of Benefits) from P N C Bank to computer work station in the Business
Office. Initiates download of electronic files to R P M S-Accounts
Receivable module. Monitors, identifies and reports any application
problems with non-H I S (Envoy) programmers. Provides hardcopy
835 reports to Finance and to Tsaile Health Center.
3% Incumbent safeguards the contents of the alternate resources
program health insurance claims as privileged communication which
disclosure of information only within the limits of I H S policy.
2% Completes special projects within required time frame to ensure
compatibility of project specifications.
5% Verify the accuracy of payment history for the period involved,
determines the extent of underpayment or overpayment, if any. Responsible
for assisting in the timely resolution of unidentified cash received
by the hospital according to hospital policy and procedures.
III. FACTORS:
Factor 1 – Knowledge Required by the Position
Knowledge of extensive and diverse accounting, other financial
regulations, operations, and procedure governing a wide variety
of transactions involving nonstandard patient accounts, complaints
or discrepancies.
Knowledge of a variety of accounting transactions and documents,
accounting symbolic codes, account structures, and procedures for
setting up and crediting accounts receivable.
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 of wide variety of interrelated procedures and processes
required to assemble, review, and maintain complex accounts related
to patient account transaction (for example, adjusting accounts
or processing refunds involving numerous supporting schedules).
Knowledge of established procedures, reimbursement format, etc.,
associated with the various reimbursing third party payers.
Knowledge of resolving problems in balancing patient accounts,
adjusting discrepancies. Develops control records, verifying the
accuracy of budgetary data adjusting dollar amounts on accounts
by line item and preparing reports reflecting the discrepancies.
Knowledge of automated patient accounting system and third party
billing system to reconcile errors that require an understanding
of nonstandard procedures related to patient accounts. Provides
assistance in the development of automated patient account procedures
for clerical operations of the Business Office.
Knowledge of automated systems, ability to type, and operate a
calculator.
Knowledge of total program operations, the priorities and goals
of the Alternate Resources Program. Keeps abreast of current changes
in policy regulations on eligibility. Participates in planning,
implementation, and improvements of the accounts receivable program.
Working knowledge of I C D-9-CM and C P T/H C P C S coding terms
in order to interpret and resolve problems based on information
derived from system monitoring reports and the U B-92 and H C F
A-1500 billing forms submitted to the third party payer.
Knowledge of and ability to apply the Alternate Resources regulations;
P. L. 94-437, Title IV of Indian Health Care Improvement Act, Indian
Health Service Policy and Regulation 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 who establishes general guidance and advice, and suggests
techniques for handling unusual or nonrecurring situations, which
have no clear precedents. Incumbent works independently processing
the most difficult procedural and technical tasks or actions, and
handles problems and deviations in accordance with instructions
and policies.
Independently determines the types and sources of information
needed to complete the transaction; the nature and extend of deviation
from established requirements; and whether standard techniques,
methods or procedure are appropriate for assignments.
Factor 3 – Guidelines
Guidelines include established agency policies and procedures,
federal codes and manuals, specific related regulations and processing
manuals. The incumbent uses judgement to locate and select the
most appropriate guide, and is expected to use judgement and initiative
in handling aspects of the work not completely covered. Makes minor
deviations in guidelines to adapt to specific cases.
The incumbent makes decisions, devises solutions, and takes action
based on program knowledge related to patient accounts. Interprets
considerable data to identify problems and determine reason for
non-payment on patient accounts. Resolves issues, recommends and
implements solutions and revises or develops alternative methods
for resolution.
Factor 4 – Complexity
Patient account support duties involve different and unrelated
processes and methods. Position works with various programs which
cover different states and each health insurance program having
different benefits, deductible, and eligibility requirements. Incumbent
makes recommendation for claims, verifying factual data or making
other determinations based on a case by case review of pertinent
regulations, documents or issues involved in each assignment or
situation. Determines how each step of the accounts receivable
process should be performed in accordance with available guidelines
and instructions, and proceeds accordingly. At each stage of the
process, decides whether proper procedures and being followed.
Incumbent downloads electronic files from (3) major Third Party
Payers. The work involves working with programmers from private
companies, contracted for these services. Monitors all electronic
files received and identifies and problems. Problems are immediately
reported to the programmers. The incumbent processes secondary
and tertiary billing after posting payment of initial claim. The
work involves knowledge of third party billing requirements by
each payer, and ability to make accurate determination if the claim
is secondary or tertiary, by reviewing accounts receivable posting.
Factor 5 – Scope and Effect
The position applies specific rules, regulations or procedures
to perform a full range of related accounting and technical tasks
that are identified in the Business Office third party collection
process. The incumbent assists in the posting of payments and contractual/adjustments
due for services rendered to Indian Beneficiaries and Non-Beneficiaries
alike. The work affects the organization’s records, program
operations and service to clients. The work also ensures the integrity
of the overall accounts receivable program, its basic design and
the adequacy of the overall operation of the Business Office and
various operating programs.
Factor 6 – Personal Contacts
Regular and recurring contact are with employees in the hospital,
with local and state agencies, third party payers, Medicare and
Medicaid fiscal intermediaries.
Factor 7 – Purpose of Contacts
The purpose of contact are to plan and coordinate the cash posting
functions of the Business Office. This includes resolution of problems
pertaining to posting of remittance and contractual/adjustments
to patient receivables, and to resolve any unidentified remittances
received for health care services rendered.
Factor 8 – Physical Demands
>
The work is primarily sedentary with some physical requirements. Lifts or carries
files, supplies or equipment; walks and stands to interact between all disciplines
within the facility; stoops and picks up objects from the floor and have full
use of hand and arms to operate office equipment such as computer, calculator,
printer and fax.
Factor 9 – Work Environment
Work is performed in the Business Office setting.
Other Significant Facts
The Privacy Act of 1974 mandates that the incumbent 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 civil and criminal penalties
for unlawful disclosure of records, violations shall be cause for
adverse action
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