Accounting Clerk Services
Navy Medicine West
Naval Health Clinic Oak Harbor
Accounting Clerk will provide services to include patient appointing, customer service, and other medical administrative services to support the overall mission for the Fleet Centered Medical Home Program to provide high quality healthcare and support to operational forces. Personnel will be utilizing electronic health records, and electronic billing system in the process of account maintenance and accounting support work requiring a basic understanding of accounting. Policies and procedures to examine, verify and maintain and reconcile accounts and accounting data, prepare and analyze reports.
Employees shall perform a full range of tasks consistent with their profession, education, training, experience, and assigned responsibilities.
1. The contractor shall follow the MTF (Medical Treatment Facility) Standard Operating Procedures (SOPs) to provide administrative support services to the MTF.
1.2. The contractor shall receive, greet, and inform patients, visitors, and hospital personnel and provide accurate responses in a friendly, courteous, and concerned manner.
1.3. The contractor shall fax, copy, scan, print, and type documents to complete daily tasks listed within this contract and the MTF SOPs.
1.4. The contractor shall utilize the Composite Healthcare System (CHCS), the Armed Forces Health Longitudinal Technology Applications (AHLTA), and various other databases in support of patient care and to satisfy administrative requirements.
1.5. The contractor shall maintain a level of productivity comparable with that of other individuals performing similar services.
1.6. The contractor shall complete orientation training required by the MTF for new personnel.
1.7. The contractor shall complete all annual training required by the MTF. This includes annual information awareness training and HIPAA training.
SPECIFIC TASKS FOR ACCOUNTING CLERK – NH Oak Harbor Uniform Business Offices.
1. The contractor shall process approximately 240 accounts each month, totaling approximately 2800 in a 12-month period. This approximately equates to over 126,720 key stroke transactions annually. The term “account”, in general, pertains to a financial or receipt record for one beneficiary with an associated preliminary and/or official account number within a specific period and/or for a specific purpose.
1.2 The contractor shall maintain 100 percent compliance with the U.S. Health Insurance Portability and Accountability Act (HIPAA)
1.3 The contractor shall provide prompt and courteous customer services in person, by telephone, and written communication.
2. BILLING OF THIRD PARTY CLAIMS. The Contractor shall complete the tasks as listed in the PWS of the basic contract.
3. POSTING OF PAYMENTS AND DENIALS. The Contractor shall complete the tasks as listed in the PWS of the basic contract.
4. INSURANCE VERIFICATION. The Contractor shall complete the tasks as listed in the PWS of the basic contract.
5. MEDICAL SERVICE ACCOUNTS (MSA). The Contractor shall complete the tasks as listed in the PWS of the basic contract.
6. MEDICAL AFFIRMATIVE CLAIMS (MAC). The Contractor shall complete the tasks as listed in the PWS of the basic contract.
7. WORKMANS COMPENSATION (L&I). The Contractor shall complete the tasks as listed in the PWS of the basic contract, as well as the following:
7.1. The contractor shall investigate reports of Industrial Injury or Occupational Disease received.
7.2. The contractor shall compile claims and copies of the supporting medical records for submission to respective entity/agency.
7.3. The contractor shall manually create claims from documents that were submitted to coding to verify for accuracy of the medical encounter.
TASKS FOR ACCOUNTING CLERICAL SUPPORT
1. BILLING OF THIRD PARTY CLAIMS
1.1. The contractor shall utilize the claims program to create claims.
1.2. The contractor shall create claims by reviewing the encounters in the claims program to determine whether the encounter is billable which shall include evaluating the OHI and other information.
1.3. The contractor shall compare the OHI information in the Composite Health Care System (CHCS) and other sources with the information in the claims program.
1.4. The contractor shall enter manual claims into the claims program for encounters that contain incorrect information in the existing file, or for billable encounters that do not appear in the claims program.
1.5. The contractor shall by submit complete claims by electronic transmission or shall print and mail complete claims to the OHI company.
2. POSTING OF PAYMENTS AND DENIALS
2.1. The contractor shall post payments and denials into the claims program which may include researching the claims program to acquire the Control number for the claim.
2.2. The contractor shall balance the amounts of the checks deposited and reported to the Defense Finance and Accounting Service (DFAS) with the amounts posted into the claims program.
2.3. The contractor shall reconcile the Third Party Collection Program (TPCP) accounts with the deposit and reporting records.
3. INSURANCE VERIFICATION
3.1. The contractor shall evaluate the Department of Defense (DD) 2569’s form received from the clinics for completeness.
3.2. The contractor shall scan and copy the DD 2569’s into the AHLTA Clinical Notes record for the patient.
3.3. The contractor shall contact the patient to complete or verify questionable information on the DD 2569.
3.4. The contractor shall contact the OHI company by phone, their website, or in writing to verify the OHI information contained on the DD 2569.
3.5. The contractor shall verify the OHI information entered or updated in the Patient Insurance Information (PII) module of CHCS.
4. MEDICAL SERVICE ACCOUNTS (MSA)
4.1. The contractor shall investigate the claims that print from CHCS to determine whether the claim is billable.
4.2. The contractor shall send the billable claims to the patients.
4.3. The contractor shall send follow-up letters from CHCS.
4.4. The contractor shall print reports for Interagency Billing (IAB) from CHCS and will verify the eligibility of patients, and complete a cover sheet and a Standard Form (SF) 1080.
5. MEDICAL AFFIRMATIVE CLAIMS (MAC)
5.1. The contractor shall investigate reports of injuries that may result in a MAC case. The reports can be from various sources, to include the MAC information form completed at the clinics. MAC is also known as Third Party Liability (TPL).
5.2. The contractor shall produce claims and acquires copies of the supporting medical records for submission to Medical Care Recovery Unit (MCRU) at the Office of the Judge Advocate General in San Diego, California.
5.3. The contractor shall manually create claims and during production of a claim verifies the correctness of the medical coding for the encounters.
HOURS OF OPERATION
0700 to 1600, Monday through Friday. Services are not required on weekends or federally observed holidays.
1. Requirements for current certification in American Heart Association Basic Life Support (BLS) for Healthcare Providers or American Red Cross CPR (Cardio Pulmonary Resuscitation) will be specified in the task order if applicable.
2. Be a U.S. Citizen
3. Possess a High School Diploma or GED certificate.
4. Possess one year of experience providing medical administrative support services.
5. Possess experience using basic software applications, e.g. Microsoft Word and Excel.
6. Possess one year of medical billing and thorough familiarity with health insurance industry practices.