signed_SOW_MSA_PRC.pdf

Department of Health and Human Services Indian Health Service

Statement of Work (SOW) Medical Support Assistant

1. PURPOSE OF THE PROJECT

The Claremore Indian Hospital (CIH), Indian Health Services (IHS) has a requirement for a four (4) Part-time or Full-time Medical Support Assistants under the direction of the Purchased/Referred Care Supervisor. The incumbent services as a Medical Support Assistant and is responsible for providing support and technical assistance to the department including medical, surgical, hospital and clinical services to all eligible beneficiaries in conjunction with or in lieu of IHS facilities. In accordance with written policies, procedures, and regulations, the PRC program provides health care to all members of federally recognized Indian tribes living within the boundaries of PRC service delivery area.

2. DETAILED DESCRIPTION OF THE TECHNICAL REQUIREMENTS

The contractor shall perform assignments, which vary in scope and encompass a variety of program activities.

Assignments require basic knowledge of regulatory requirements of the code of federal regulations and alternate resources to perform technical assistance and consultations on referral health care program and alternate resources.

The contractor shall perform the following duties and responsibilities:

• Responsible for verifying patient eligibility in receiving routine Medical Referrals and/or emergency call-ins for treatment rendered by reviewing documentation in the patient registration regarding eligibility and alternate resources availability for services rendered.

• Incumbent maintains and utilizes the Resource Patient Management System (RPMS), Electronic Health Record (EHR) and the Referred Care Information System (RCIS) in reviewing documentation.

• Responsible for coordinating the management of the health care delivery system by providing contract medical vendors with CHS authorizations to determine an estimated cost of the services rendered, whether Inpatient or outpatient services.

• Responsible for coordination of and provision of patient education regarding the PRC program and associated requirements for eligibility. Interviews and evaluates patients for possible eligibility of an alternate resource, I.e.

Medicare, Medicaid, Veteran's Administration, and other private Insurance carriers.

• Ensures patients are referred to the Patient Benefit Coordinator for further assistance.

• Responsible for implantation of decisions made for the provision or denial of services.

Coordinates the denial and/or deferred services 11st on all medical referrals and Informs the health care provider of the status of each referral within the PRC program.

• Responsible for the preparation and distribution of all authorizations, follow up letters on outstanding purchases, and denial and/or deferred letters to the patients and contract medical providers regarding services rendered. Therefore, a qualified typist is required.

• Responsible for Interpretation of medical bills and explanation of benefits received from patients and medical providers.

• Reviews all incoming correspondence from providers.

• Responsible for determining if an authorization has been issued or has been paid using own initiative and judgment.

• Responsible for providing accurate health insurance Information to providers by verifying the Insurer's covered services to ensure no delay of payments.

• Responsible for the coordination and scheduling of all patient appointments for Purchased/Referred Care and ensures proper follow up with the vendor to ensure patient’s care is coordinated in a seamless fashion.

• Provides coordination efforts of patient inquires, both in person and via phone, and ensures each inquiry is answered in a timely and customer service friendly approach. Ensures patients are informed on the priorities for services based on policy and procedure of the Claremore Indian Hospital Purchased/Referred Care program.

• Maintains the files of completed authorizations for hospitalizations, outpatient services and updates pending patient files with documented status of all written and verbal transactions.

• Assists in the reconciliation of the current Purchased/Referred Care budget.

• Assists in the preparation, submission, and payment processes of purchase orders for services rendered.

• Audits claims processed for third party resources and proper coding.

• Utilizes knowledge in the maintenance of the Document Control Register (DCR).

3. PERIOD OF PERFORMANCE

Select One:

The base year Period of Performance will be 12 months from date of award with four (4) twelve (12) month option years.

4. LEVEL OF EFFORT

4.1. The contractor shall ensure complete orientation sessions conducted by the on-site PRC Department and the Human Resource Department.

4.2. The contractor shall have basic knowledge of regulatory requirements of the code of federal regulations and alternate resources to perform technical assistance and consultations on referral health care program and alternate resources.

4.3. The contractor will work shifts of 8 hours with an unpaid lunch period, Monday through Friday with the option of teleworking if needed or directed per the Purchased/Referred Care Supervisor.

4.4. The contractor will not work Federal holidays.

4.5. Training: Will be provided by CIH on IHS specific rules and regulations.

5. SPECIAL REQUIREMENTS

5.1. In accordance with HHSAR 304.1300(b) non-routine contractor employees shall comply with OPDIV

DHHS/SE Region – Human Resources, Security Clearance Guidance – Visitors (3/29/12) policy for contract performance period. Contractor employees will be required to obtain a visitor’s pass upon arrival for services from Facilities Management. - (Security Clearance for on-site human services)

5.2. The US PHS Claremore Indian Hospital is a tobacco/smoke free environment (buildings and grounds). No tobacco/smoking use will be tolerated during service.

5.3. Security Requirements: Contractor personnel will be required to contact the government designated point of contact upon arrival when reporting for service calls or delivery supplies. The contractor shall be responsible for the security of all organizational information. Current rules and regulations applicable to the premises, where the work shall be performed shall apply to the contractor and its employees while working on the premises. These regulations include but are not limited to, escort by Claremore Indian Hospital official, presenting valid identification, smoking restriction and any safety procedures.

5.4. The contractor shall not disclose or cause to disseminate any information concerning operations of

Claremore Indian Hospital. Such action(s) could result in violation of the contract and possible legal actions.

5.4.1. All inquiries, comments, or complaints arising from any matter observed, experienced or learned of as a result of or in connection with the performance of the contract, the resolution of which may require the dissemination of official information, shall be directed to the government’s designated representative.

6. DELIVERABLES AND REPORTING REQUIREMENTS

6.1. Contractor Point of Contact: The contractor shall furnish one designated point of contact (POC) to the government’s designated representative for coordination of supplies, delivery, and/or maintenance. The POC will be empowered to make daily decisions to ensure that the contract implementation and day-to-day maintenance meets the terms and conditions of this contract.

6.2. Contractor’s Phone Numbers: The contractor shall provide a toll-free telephone number for service calls, which must be answered during at least eight working hours, between 8:00 am and 4:30 pm, Monday through Friday.

6.3. Personnel Qualifications: The Medical Support Assistants Knowledge required for this position are as listed:

• Referring/answering calls and questions

• Determine eligibility for service

• Assemble PRC referrals in their required order and sequence for Alpha letter distribution

• Alternative resources – Medicare, Medicaid, Private Insurance, and Affordable Care Act.

• Medical procedures, various medical specialties and medical terminology are needed to coordinate patient care with contracted vendors.

• Retrieve a variety of physicians’ orders for patient activities, diets, tests, and treatments.

• Research/refer patients to appropriate clinics for care

• Answer questions regarding routine procedures

• Relay instructions to patients on referred care decisions

• File referred care results and distribute to appropriate staffs for purchase order (PO) assignment

• Relay information regarding the patient’s referral status

• Compiling/submitting data on referred care and treatment plans

7. GOVERNMENT FURNISHED PROPERTY, FACILITIES AND SERVICES

7.1. The Government shall provide use of furnished facility space, equipment, and supplies required to perform work under the contract.

8. CONTRACTOR FURNISHED PROPERTY, FACILITIES AND SERVICES

8.1. Required personnel, materials, supplies and equipment: The contractor shall furnish all personnel, materials, supplies and equipment required to perform work under the contract.

9. CHANGES TO THE STATEMENT OF WORK (SOW)

Any changes to this SOW shall be authorized and approved only through written correspondence from the Contracting Officer. Costs incurred by the contractor through the actions of parties other than the Contracting Officer shall be borne by the contractor.

10. DELIVERABLES/PERFORMANCE MATRIX

10.1. Contractor was on-time and completed tasks as assigned: Yes No

10.2. Contractor followed the rules and regulations set by OCA: Yes No

10.3. The contractor addressed any complaints or concerns: Yes No

Department Supervisor Signature:_________________________

Administrative Officer Signature:_________________________

30%

30%

25% l

I. Introduction

Purchased/Referred Care

Medical Support Assistant (OA) GS-0679-06

This position Is located In the Purchased/Referred Care (PRC) department of the Claremore Indian Hospital (CIH). The Purchased/Referred care program provides health care to all members of federally recognized lndlan tribes living within the boundaries of the Purchased/Referred care delivery area.

Under the direction of the Purchased/Referred care Supervisor, the incumbent services as a Medical

Support Assistant and Is responsible for providing support and technical assistance to the department Including medical, surgical, hospital and clinical services for the service unit Indian population.

11. MAJOR DUTIES AND RESPONSIBILITIES

Responsible for verifying patient eligibility In receiving routine Medical Referrals and/or emergency call-Ins for treatment rendered by reviewing documentation In the patient registration regarding ellglblllty and alternate resources availability for services rendered. Incumbent maintains and utlllzes the Resource Patient Manasement System (RPMS), Electronic Health Record (EHR) and the Referred care Information System (RCIS) In reviewing documentation. Responsible for coordinating the management of the health care delivery system by providing contract medical vendors with CHS authorizations to determine an estimated cost of the services rendered, whether Inpatient or outpatient services. Responsible for coordination of and provision of patient education regarding the PRC program and associated requirements for eligibility. Interviews and evaluates patients for posstble ellgiblllty of an alternate resource, I.e. Medicare, Medicaid, Veteran's Administration, and other private Insurance carriers. Ensures patients are referred to the Patient Benefit Coordinator for

� further assistance.

- Responsible for Implementation of decisions made for the provision or denial of services.

Coordinates the denial and/or deferred services 11st on all medical referrals and Informs the health care provlder of the status of each referral within the PRC program. Responsible for the preparation and distribution of all authorizations, follow up letters on outstanding purchases, and denial and/or deferred letters to the patients and contract medical providers regarding services rendered.

Therefore, a qualified typist is required. Responsible for Interpretation of medical bills and explanation of benefits received from patients and medical providers. Reviews all incoming correspondence from providers. Assist In processes all authorizations and provides Information to the Ascal Intermediary, Blue Cross Blue Shield of New Mexico, regarding authorization of payment.

Responsible for determining If an authorization has been issued or has been paid using own

Initiative and judgment. Responsible for providing accurate health insurance Information to providers by verifying the Insurer's covered services to ensure no delay of payments.

J

- Responsible for the coordination and scheduling of all patient appointments for Purchased/Referred care and ensures proper follow up with the vendor to ensure patient's care Is coordinated in a seamless fashion. Provides coordination efforts of patient inquires, both in person and via phone, REMARKS:

Position Is a Medical Support Assistant (OA), GS-0679-06, providing clerical support and technical assistance to the service unit Purchased/Referred Care (PRC) manager on matters Involving PRC services.

Duties trust (includes access to or processing of personal information such as that protected by the Privacy Act (PA) of 1974, exempt from disclosure under the Freedom of Information Act (FOIA), financial data, or privileged information involving the award of contracts, contractor proprietary information, etc.)

Government service delivery, including customer service or public liaison duties

Other activities demanding a significant degree of public trust (Specify any other specific duties that are not otherwise covered):

This position is covered by public law 630

Degree of Potential for Compromise or Damage unauthorized disclosure of which could cause very limited damage to individuals, business entities, or government programs or operations or any potential damage is limited to the local level

• Duties are carried out under such restrictive controls that the risk of violating the public's trust is extremely limited

Moderate impact Duties involve customer service responsibilities and/or public liaison that could negatively impact the public's trust through moderate damage/harm to:

• The integrity or efficiency of the service

• Individuals or business entities

• Government programs or operations impacting the public's trust

• Duty presents the possibility for a fair amount of harm or serious damage to the public's trust

Adjustment for Scope of Program and Correlation to Extent of Impact

Program Scope and Impact

Adjustment for Scope of Program and Correlation to Extent of Impact

Level of Supervision

Adjustment for level of supervision or other controls

Agency Impact

• Program operations affect only one agency.

Misconduct or damage would have potential for a local impact on the agency, and/or the individuals or private entities affected by the agency.

Ability to act independently

Periodic, ongoing review - ability to act independently a lot of the time

• Ongoing spot review from a perspective of policy and organizational concerns by a superior with expertise in the technical aspects of the duties performed.

Designator's Name: Kyle Bodine HR Assistant

Designator's Signature: ��8�� {I

Date: _____ _ 03/26/2021

Indian Health Service Human Resources Office (HRO) Bargaining Unit Status Code Determination and LRO Verification

Title: MSA (OA) Organizational Title:

Pay Plan/Series/Grade: GS-0679-06 Organization: Claremore Indian Hospital FLSA Status: Non-exempt Administrative Code: GFKA2 PD Number: CM1075 Location: Claremore, OK BUS Determination: 1854 BUS Code may change if Duty Location changes

(because of remote work or other).

Notes:

- A unit shall not be determined to be appropriate under this section solely on the basis of the extent to which employees in the proposed unit have organized, nor shall a unit be determined to be appropriate if it includes:

Reference: 5 USC § 7112 (b)(1) - (7).

1. Except as provided under Section 7135 (a)(2) of this title, any management official or supervisor.

2. A confidential employee.

3. An employee engaged in personnel work in other than a purely clerical capacity.

4. An employee engaged in administering the provisions of this chapter.

5. Both professional employees and other employees, unless a majority of the professional employees vote for inclusion in the unit.

6. Any employee engaged in intelligence, counterintelligence, investigative or security work which directly affects national security.

7. Any employee primarily engaged in investigation or audit functions relating to the work of individuals employed by an agency whose duties directly affect the internal security of the agency, but only if the functions are undertaken to ensure that the duties are discharged honestly and with integrity.

- HRO is responsible for accomplishing a BUS code review in order to process actions such as an appointment, promotion, reassignment or any other temporary or permanent action that moves an employee to a different position.

- Duties that have not actually been assigned to an employee will be considered assigned duties where it can be shown that, apart from the position description, the employee has been informed the duties will be assigned, the nature of the job clearly requires the duties and the employee is not performing the duties solely because of a lack of experience. Food Safety and Inspection Service, 105 LRP 60863, 61 FLRA 397 (FLRA 2005); Yuma Projects Office, 90 FLRR 1-1455, 37 FLRA 239 (FLRA 1990).

- Bargaining unit determinations are made based on duties actually performed. The PD needs to reflect the full spectrum of duties to be performed. Pentagon Force Protection Agency, 62 FLRA 164, 107 LRP 57744 (FLRA 2007).

- An employee being provided an assignment or different position (different Position

Description and Position Number), this personnel action necessitates a new review of the BUS Code.

Bargaining Unit Determination Analysis of Duties:

_Yes_ Review duties and responsibilities assigned and determine whether or not a new position is included in the BU as described from the FLRA Certification of Representative.

_NP Is position a professional (P) or non-professional (NP) position?

_No _ Does position meet any exclusions as dictated by 5 USC § 7112 (b) or is an exempt employee who administers “any provisions of the law relating to labor-management relations” – 5 USC § 7112 (c)?

_No__ management official

_No__ supervisor

_No__ confidential employee

_No__ employees engaged in personnel work

_No__ employees engaged in national security activities

_No__ employees involved in internal audit functions

Note: If position is a possible exclusion insure it is researched and supported by law and/or case law.

L/R Findings (Facts and Analysis):

Duties were reviewed to determine if the incumbent would qualify for an exemption or exclusion from the bargaining unit as defined by 5 USC § 7112 (b). To qualify for exclusion from the unit based on the incumbent being a management official, the incumbent’s duties should reflect that they are required or authorized to formulate, determine, or influence the policies of the Agency.

The incumbent serves as a Medical Support Assistant responsible for providing support and technical assistance to the PRC department including medical, surgical, hospital and clinical services for CIH.

Position provides clerical support and technical assistance to the CIH Purchased/Referred Care (PRC) manager on matters involving PRC services. The incumbent does not appear to be responsible for, or authorized to act as a member of Agency management. The incumbent does not appear to have authority or responsibility for independently determining Agency policies related to their activities. Additionally the incumbent does not supervise other employees; does not perform duties involved with labor relations issues that would qualify the incumbent as a confidential employee; does not perform duties that would qualify as personnel work; does not perform duties that would be considered “security work” as defined by 5 USC § 7112 (b)(6) nor meet the requirements of FLRA to be considered “security work” for the statute; and does not perform duties involved with internal auditing functions.

Article 2 of the Collective Bargaining Agreement effective February 25, 2011, has included the following for Claremore Indian Hospital for eligibility for BU Status. 2.2 INCLUDED: All nonsupervisory, nonprofessional and professional employees employed by Claremore Service Unit including employees of Claremore Service Hospital, Jay, Okmulgee and Miami, Oklahoma Health Centers.After review of duties described in the position description, the position is not excluded from the bargaining unit as 5 USC § 7112 (b)(1) applies, and the BUS Code should be 1854; BUS Code may change if Duty Location changes (because of remote work or other).

Reviewed by and date:

Quinn S. Proctor HR Specialist/Classification

Quinn S.

Proctor -S

Digitally signed by Quinn S. Proctor -S Date: 2022.09.19 15:44:01 -05'00'

Pay Plan/Series/Grade: GS-0679-06 Organization: Claremore Indian Hospital FLSA Status: Non-exempt Administrative Code: GFKA2 PD Number: CM1075

3. An employee engaged in personnel work in other than a purely clerical capacity.

duties and the employee is not performing the duties solely because of a lack of is included in the BU as described from the FLRA Certification of Representative.

_NP Is position a professional (P) or non-professional (NP) position?

_No _ Does position meet any exclusions as dictated by 5 USC § 7112 (b) or is an exempt

_No__ confidential employee

_No__ employees engaged in personnel work

L/R Findings (Facts and Analysis):

Duties were reviewed to determine if the incumbent would qualify for an exemption or exclusion from the bargaining unit as defined by 5 USC § 7112 (b). To qualify for exclusion from the unit based on the incumbent being a management official, the incumbent’s duties should reflect that they are required or authorized to formulate, determine, or influence the policies of the Agency.

This position is responsible for verifying patient eligibility in receiving routine Medical Referrals and/or emergency call-Ins for treatment rendered by reviewing documentation In the patient registration regarding ellglblllty and alternate resources availability for services rendered, responsible for implementation of decisions made for the provision or denial of services, responsible for the coordination and scheduling of all patient appointments for Purchased/Referred care and ensures proper follow up with the vendor.

This position is a Medical Support Assistant (OA) and responsible for providing support and technical assistance to the Purchase/Referred Care Department. The incumbent does not appear to have authority or responsibility for independently determining Agency policies related to their activities. Additionally the incumbent does not supervise other employees; does not perform duties involved with labor relations issues that would qualify the incumbent as a confidential employee; does not perform duties that would qualify as personnel work; does not perform duties that would be considered “security work” as defined by 5 USC § 7112 (b)(6) nor meet the requirements of FLRA to be considered “security work” for the statute; and does not perform duties involved with internal auditing functions.

Article 2 of the Collective Bargaining Agreement effective February 25, 2011, has included the following for Claremore Indian Hospital for eligibility for BU Status. 2.2 INCLUDED: All nonsupervisory, nonprofessional and professional employees employed by Claremore Service Unit including employees of Claremore Service Hospital, Jay, Okmulgee and Miami, Oklahoma Health Centers.After review of duties described in the position description, the position is not excluded from the bargaining unit as 5 USC § 7112 (b) applies, and the BUS Code should be

Date: 2022.09.26 10:02:31 -05'00'

Position Description Medical Support Assistant (Purchased Referred Care)

GS-0679-05

I. INTRODUCTION

This position is organizationally located in the Purchased Referred Care (PRC) Branch, Indian Health Service, Claremore Indian Hospital, Claremore, Oklahoma. The purpose is to provide support and technical assistance to the service unit PRC manager on matters involving Purchased Referred Care services including medical, surgical, hospital and clinical services to all eligible beneficiaries in conjunction with or in lieu of IHS facilities. In accordance with written policies, procedures, and regulations, the PRC program provides health care to all members of federally recognized Indian tribes living within the boundaries of PRC service delivery area.

Employee performs assignments which vary in scope and encompass a variety of program activities.

Assignments require basic knowledge of regulatory requirements of the code of federal regulations and alternate resources to perform technical assistance and consultations on Purchased Referred Care program and alternate resources.

II. DUTIES AND RESPONSIBILITIES

Incumbent receives referrals from physicians and emergency self-referrals for Purchased Referred Care services; evaluate each case according to current priorities and availability of funds.

Responsible for preparing, processing, and issuing medical, hospital and consultation authorizations;

estimates charges for referrals in accordance with contracts and advises patients of their referral appointments. Explain the privacy act signature block and follows-up to see if appointments have been kept:·Set-up phone patient appointments, receives emergency call-ins, talk with patients regarding bills, follow-up appointments, and has basic knowledge of medical procedures, various medical specialties and medical terminology to select providers, arrange appointments, and discuss procedures recommended. 30%

Incumbent is responsible for making determinations as to patient eligibility, scope, and priority for the Purchased Referred Care Program. Fiscal and statistical data is obtained through the use of the Purchased Referred Care automated software system-CHMIS. Incumbent is responsible for entering and verifying all Purchased Referred Care purchase orders, payments, cancellations, and supplements. 20%

Issue denials based on applicable PRC regulations, policies, and practices. Utilize the Purchased Referred Care health automated software system to enter medical and financial data. Counsel patients on the appeal process when denials are issued. 20%

Provide informal reports on the status of fund expenditures on a periodic basis; Prepare internal financial analysis reports on each account maintained in the Service Unit document control registers, including amounts currently budgeted, obligated, and unobligated balances. Respond to spreadsheets on status of claims. 15%

Incumbent must be able to identify error messages displayed on the automated system and take corrective action to resolve problems resulting from incorrect error messages displayed on the automated system and resolve problems resulting from incorrect raw data which may include but not limited to, Purchased Referred Care data, common accounting numbers (CANS}, object class codes, Facility Codes, County/Community Codes, ICD-9 Codes, CPT Codes. 10%

Incumbent is responsible for the printing and maintenance of Obligation Register and all other Purchased Referred Care documents and for the weekly printing and distribution of the Obligation Register report used through the Purchased Referred Care Area Office Toolbox. 5%

III. Factors

Factor 1 Knowledge Required by the Position The position requires knowledge of basic and established procedures related to routine and repetitive aspects of PRC support work, i.e., knowledge of: Working closely with supervisor to avoid mistakes in dealing with individuals seeking medical care.

Incumbent has extensive knowledge of eligibility requirements of IHS programs, as well as, extensive knowledge of Third Party Billing procedures, availability of health resource programs, rules of eligibility on medical procedures and must have basic knowledge of medical terminology, medical care practice, and procedures and elementary practical anatomy and physiology, medical techniques, and major disease processes, diagnoses, procedure tests, and other specialized terms.

Must have extensive knowledge of personal or menu driven computers, software and output (printer) equipment and be able to type from a set format with minimum of errors; therefore a qualified typist is required.

Extensive Knowledge of positive interview techniques, business office functions, policies and procedures to be able to refer inquiries to appropriate personnel.

Obtain information via telephone or personal inquiries on the status of patient billing, i.e., charges, payments, and outstanding balances, receives visits and telephone calls from hospital personnel, patient, and private vendors. Incumbent refer calls to the supervisor or the appropriate personnel with Purchased Referred Care. Incumbent will maintain, at all times, professional telephone etiquette in all contracts with hospital personnel, patients, and private vendors.

Maintain files of elective procedures, prepares authorizations, and schedules admissions in CHS facilities when available and performs a variety of supportive tasks as assigned.

Factor 2 Supervisory Controls Work is performed under the general supervision and guidance of the Supervisory Health System Specialist, who provides detailed instruction on new or changed procedures. The employee performs work as instructed and consults with the supervisor or higher grade co-workers on problems not specifically covered by the original instructions, or for clarification of instructions. The supervisor closely reviews work while in progress and when completed for accuracy, adequacy, and adherence to instructions and established procedures.

Factor 3 Guidelines Procedures, i.e., format, preparation, and arrangement of correspondence and distribution of copies have been established. Specific guidelines, i.e., agency or unit instructions, directives, notices, manuals, or technical dictionaries are available for reference.

The employee uses judgement in locating, selecting, and applying the most appropriate alternative among the various guidelines covering similar situations involving significant deviation from established guidelines and referred to the supervisor. Incumbent receives verification from supervisor when making minor deviations to adapt the guidelines to specific cases.

Factor 4 Complexity The work involves performing relation processing and procedural tasks in support of transportation related functions. Employee makes decisions, i.e., how to sort incoming documents, locate and assemble information, and correct errors. This is completed by reviewing similar cases or standard operation procedures and selecting from among clearly recognizable alternatives.

Employee takes action using established instructions, practices, or precedents for format, content, and processing of PRC documents and requests. The employee decides what needs to be done by choosing various options that require recognition of and differences among a few easily recognizable alternatives.

Factor 5 Scope and Effect

The purpose of the work is to limited, repetitive, or closely related tasks, i.e., sorting and distributing documents, entering routine patient information into a data base system, and/or verifying repetitive types of data.

Factor 6 Personal Contacts Contacts are with hospital employees in the immediate organizational unit, with employees outside an organization, with members of the general public and with patients who require the use of Purchased Referred Care Services.

Factor 7 Purpose of Contacts The purpose of contacts is to obtain, clarify, or provide information related to daily support assignments, i.e., contacts may be to obtain missing information, advise of the status of actions, or verify information needs.

Factor 8 Physical Demands The employee performs work that requires some physical effort such as standing, walking, bending, or sitting. There are no special physical demands. Work is mainly sedentary but requires some bending, standing, walking, reaching, and carrying of such things as patient records, light supplies, paper charts, and letter mail.

Factor 9 Work Environment The work is normally performed in an office setting and the work area is adequately lighted, heated, and ventilated. Work involves everyday risks or discomforts that require taking normal safety precautions typically associated with offices. Work is typically performed in an adequately lighted and heated office environment.

EVALUATION STATEMENT

Medical Support Assistant (OA), GS-0679-05 – CM1082

Organizational Location:

Claremore Indian Hospital

Standards Referenced:

Job Family Position Classification Standard for Assistance and Technical Work in the Medical, Hospital, Dental & Public Health Group, GS-0600 May 2001; Medical Support Assistance, GS-0679.

Title/Series Determination:

The incumbent of this position serves as a Medical Support Assistant (OA) who will provide support services to the Purchased Referred Care (PRC) department within the Claremore Indian Hospital.

The purpose is to provide support and technical assistance to the service unit PRC manager on matters involving Purchased Referred Care services including medical, surgical, hospital and clinical services to all eligible beneficiaries in conjunction with or in lieu of IHS facilities. Specifically the incumbent will receive patient referrals from physicians and emergency call-ins for purchased referred care services.

The incumbent evaluates each case as to current priorities and availability of funds; makes determinations as to patient eligibility, scope, and priority for the PRC Program; utilizes the PRC health automated software system to enter medical and financial data; provides informal reports on the status of fund expenditures on a periodic basis; and performs assignments which vary in scope and encompass a variety of program activities. Such medical support work is related to the medical support assistance duties depicted in the GS-0679 medical support series definition. A qualified typist is required; therefore, the addition of (OA) office automation will be added to the title. Such assignments are comparable to the GS-0679 series definition and are titled Medical Support Assistant (OA), GS-0679.

Title/Series Allocation: Medical Support Assistant (OA), GS-0679

Grade Level Determination:

Grading of positions classified to Medical Support Assistant, GS-0679 is accomplished by analysis and assignments of factor level descriptions and point value based on grading criteria contained in the cited standard. The following evaluation is based on these criteria.

Factor Factor Level Points Assigned

1. Knowledge Required 1-3 350

2. Supervisory Controls 2-3 275

3. Guidelines 3-2 125

4. Complexity 4-2 75

5. Scope and Effect 5-2 75 6/7. Personal Contacts & Purpose of Contacts

2b 75

8. Physical Demands 8-1 5

9. Work Environment 9-1 5 Total Points 985

By application of the Grade Conversion table of the Assistance and Technical Work in the

Medical Hospital, Dental & Public Health Group, GS-0600 standard for Medical Support Assistant GS- 0679, total points derived are included in the range of point values for Grade Level GS-05.

Grade Level Allocation: GS-05

Final Position Classification: Medical Support Assistant (OA), GS-0679-05

Marla Avila-Frank Supv Human Resources Specialist/ Classification February 11, 2022

Marla C.

Avila-frank -S

Digitally signed by Marla C. Avila-frank -S Date: 2022.02.11 17:52:09 -06'00'

DEPARTMENT OF HEALTH & HUMAN SERVICES Office of the Assistant Secretary for Administration Office of Human Services

HHS FLSA Classifier Checklist

Fair Labor Standards Act (FLSA) Checklist This form is to be completed for each grade in a career ladder. Note: it is possible for different grades within a career ladder to have different FLSA designations (for example, non-exempt at lower grades, or the work is procedural in nature, and exempt at higher grades in the career ladder requiring more analytical skills to complete the tasks). A completed and signed checklist must be attached to each classified position description and statement of difference (if applicable).

Instructions: Complete the fields below and check the criteria that are applicable to the position:

A. REQUIRED POSITION INFORMATION

Position Title: Pay Plan/Series:

Position Number: Office/Organization:

Administrative Code: Job Code:

B. NON-EXEMPT CRITERIA

1. Salary-based non-exemption (5 CFR 551.203) � Employee annual rate of basic pay is less than $23,660.

2. Non-exemption of certain employees (5 CFR 551.204) � Position is non-supervisory and engaged in equipment operation, or is a protective or clerical occupation.

� Position involves technician work properly classified at the GS-09 level or below.

� Position is nonsupervisory in the Federal Wage System or other comparable wage system.

C. EXEMPTION CRITERIA

1. Executive Exemption Criteria (5 CFR 551.205) � Primary duty of the position is management or supervision; work involves customarily and regularly directing the work of subordinates and has the authority to hire, remove, or evaluate performance as well as make recommendations on employment issues that are given particular weight by higher-level supervisors or managers.

Medical Support Assistant (OA) GS-0679

IHS/OCAO/Claremore

GFKA2 CM1082

2. Administrative Exemption Criteria (5 CFR 551.206) � Primary duty is performance of office or non-manual work directly related to the management or general business functions. The work involves the exercise of discretion and independent judgment with respect to matters of significance.

3. Professional Exemption Criteria (5 CFR 551: 208, 209, 210) � 5 CFR 551.208 Learned Professionals: Primary duty is performance of work requiring advanced knowledge in a field of science or learning including the traditional professions of law, medicine, theology, accounting, actuarial computation, engineering, architecture, teaching, pharmacy, various types of physical, chemical and biological sciences, and other similar occupations that have a recognized professional status; entrance into these professions requires a prolonged course of specialized intellectual instruction.

� 5 CFR 551.209 Creative Professionals: Primary duty is performance of work requiring invention, imagination, originality or talent in a recognized field of artistic or creative endeavor such as music, acting, writing, and the graphic arts. Exemption depends upon the extent of invention, imagination, originality or talent of the employee; exemption does not apply to work that can be produced by a person with general manual or intellectual ability and training.

� 5 CFR 551.210 Computer Employees: Primary duty consists of the application of systems analysis techniques and procedures, including consulting with users to determine hardware, software or system functions specifications; OR design development, documentation, analysis, creation, testing or modification of computer systems or programs; OR a combination of these duties. Exemption does not apply to employees engaged in the manufacture or repair of computer hardware and related equipment or to those whose work is highly reliant on computers but whose duties do not consist of the aforementioned. Salary based exemption applies to any computer professional compensated on an hourly bases at a rate of basic pay of $27.63 an hour and above.

4. Law Enforcement Activities (5 CFR 551.216) � Special exemption/exclusion applies to all law enforcement agents receiving availability pay.

5. Foreign Exemption Criteria (5 CFR 551.212) � Employees permanently stationed in an exempt area and spend all hours of work in a given work week in one or more exempt areas or employees not permanently stationed in an exempt area, but spend all hours of work in a given work week in one or more exempt areas. Exempt area means any foreign country, or any territory under the jurisdiction of the United States other than a State; the District of Columbia; Puerto Rico; the US Virgin Islands; American Samoa; Guam;

Commonwealth of the Northern Mariana Islands; Midway Atoll; Wake Island; Johnston Island;

and Palmyra (5 CFR 104).

Final Determination (check one): Non-Exempt Exempt

HR Specialist: Date:

Marla C. Avila-frank -S Digitally signed by Marla C. Avila-frank -S Date: 2022.02.11 17:54:56 -06'00' 2/11/2022

This position serves as a Medical Support Assistant (OA) who will provide support services to the Purchased Referred Care (PRC) department within the Claremore Indian Hospital. The purpose is to provide support and technical assistance to the service unit PRC manager on matters involving Purchased Referred Care services including medical, surgical, hospital and clinical services to all eligible beneficiaries in conjunction with or in lieu of IHS facilities. The position is classified at the GS-05 grade level and is designated as non-exempt.

Management Survey (For position risk designation)

Position location Position title Series and Grade Manager/Supervisor and telephone number

Instructions: As someone intimately familiar with agency needs and expectations in your workgroup, your input is essential in determining the appropriate risk designation level and investigative requirements for the above position. Please provide responses to the following questions.

1. Does this position require access or eligibility for access to classified information? Yes No If yes, please specify the level access:

2. Does this position involve other National Security duties? Yes No

3. Does this position involve fiduciary responsibilities? Yes No If yes, please specify the level below:

More than $50 million $10 to $50 million $2 to $10 million Under $2 million

4. What level of supervision does this position supervise?

Limited: Occasional review to ensure adherence to major policies; however, the individual conducting the review has relevant technical expertise. Ability to act independently in almost all areas almost all of the time.

Periodic: Ongoing spot review to ensure adherence to organizational policy and other concerns; the reviewer has relevant technical expertise. Ability to act independently a lot of the time.

Close Technical: All work is reviewed by a technical expert. Ability to act independently infrequently.

5. Select which level of public interaction and/or customer service will this position be involved with?

Limited (Duties involve customer service responsibilities and/or public liaison that could cause limited damage to individuals, business entities, or government programs or operations)

Moderate (Duties involve customer service responsibilities and/or public liaison that could negatively impact the public’s trust through moderate damage/harm)

Severe (Duties involve customer service responsibilities and/or public liaison that could severely impact the public’s trust through severe damage/harm)

Automatic High-Risk (Customer service responsibilities and/or public liaison that could cause inestimable damage to the public’s trust through grave damage/harm)

6. Does the position involve access to or control over personal, private, sensitive but unclassified, controlled unclassified or proprietary information? (i.e., PII, information covered by the Privacy act, HIPPA, FOIA, financial information, etc.). Yes No

7. Which of the following computer access is required?

D1 only UFMS Capital HR and/or ITAS RPMS EHR and/or EDR Other (please indicate):

8. Other (to be specified by the position risk designator): _________________________________________________________

9. Manager/Supervisor/Lead additional comments or additional duties/factors warranting consideration:

Signature: Date:

Claremore Indian Hospital Medical Support Assistant (OA) 0679-05 Jamie Rhodes; 918-342-6236

PII, HIPAA

PRC systems

Jamie Rhodes Digitally signed by Jamie Rhodes Date: 2022.02.11 13:05:53 -06'00'

Position Designation Record

Department DEPARTMENT OF HEALTH AND HUMAN SERVICES HE Agency DEPT OF HHS-INDIAN HEALTH SERVICE Supplemental Duty Position Title Medical Support Assistant(Purchased Referred Care) Position Description Series and Grade/Pay Band GS-0679 Position Description Number CM1082 Designator's Name & Title Kyle Bodine HR Assistant

Final Position Designation and Investigation

Sensitivity Level Risk Level Investigation Form Non-Sensitive Moderate Risk Tier 2 SF 85P

Label Points Total Initial Position Designation Points from Step 2 32 Adjusted Position Designation Points from Step 3 22

Summary

National Security No national Security Duties

Suitability

Duties Degree of Potential for Compromise or Damage Protection of government information technology systems (supervision or control of information technology systems, authority to bypass significant technical and operational security controls for general support systems, or access to major applications – the scope of these duties exceed that of ordinary or routine computer use)

Limited impact Aids or supports the duties in this category;

however, the responsibilities are so narrow in scope or carried out under such restrictive controls that the risk of violating the public’s trust is practically eliminated

Protection of personal, private, controlled unclassified, or proprietary information-with the potential to damage the public’s

Limited impact One or more of the following:

Access to personal, private, proprietary, or controlled unclassified information, the

Duties Degree of Potential for Compromise or Damage trust (includes access to or processing of personal information such as that protected by the Privacy Act (PA) of 1974, exempt from disclosure under the Freedom of Information Act (FOIA), financial data, or privileged information involving the award of contracts, contractor proprietary information, etc.)

unauthorized disclosure of which could cause very limited damage to individuals, business entities, or government programs or operations or any potential damage is limited to the local level Duties are carried out under such restrictive controls that the risk of violating the public’s trust is extremely limited

Government service delivery, including customer service or public liaison duties

Duties involve customer service responsibilities and/or public liaison that could negatively impact the public’s trust through moderate damage/harm to:

The integrity or efficiency of the service Individuals or business entities Government programs or operations impacting the public’s trust

Other activities demanding a significant degree of public trust (Specify any other specific duties that are not otherwise covered):

This position is covered by Public Law 101-630

Duty presents the possibility for a fair amount of harm or serious damage to the public’s trust

Adjustment for Scope of Program and Correlation to Extent of Impact

Program Scope and Impact Impact Adjustment for Scope of Program and Correlation to Extent of

Agency Impact Program operations affect only one agency.

Misconduct or damage would have potential for a local impact on the agency, and/or the individuals or private entities affected by the agency.

Level of Supervision Ability to act independently Adjustment for level of supervision or other controls

Periodic, ongoing review - ability to act independently a lot of the time

Ongoing spot review from a perspective of policy and organizational concerns by a superior with expertise in the technical aspects of the duties performed.

Designator’s Name: Kyle Bodine HR Assistant

Designator’s Signature: _________________________________ Date: _________________02/16/2022

Pay Plan/Series/Grade: GS-0679-05 Organization: Claremore Indian Hospital FLSA Status: Non-exempt Administrative Code: GFKA2 PD Number: CM1082

3. An employee engaged in personnel work in other than a purely clerical capacity.

duties and the employee is not performing the duties solely because of a lack of is included in the BU as described from the FLRA Certification of Representative.

_NP Is position a professional (P) or non-professional (NP) position?

_No _ Does position meet any exclusions as dictated by 5 USC § 7112 (b) or is an exempt

_No__ confidential employee

_No__ employees engaged in personnel work

L/R Findings (Facts and Analysis):

Duties were reviewed to determine if the incumbent would qualify for an exemption or exclusion from the bargaining unit as defined by 5 USC § 7112 (b). To qualify for exclusion from the unit based on the incumbent being a management official, the incumbent’s duties should reflect that they are required or authorized to formulate, determine, or influence the policies of the Agency.

The incumbent services as a Medical Support Assistant and responsible for providing support and technical assistance to the PRC department including medical, surgical, hospital and clinical services for CIH.

Position provides clerical support and technical assistance to the service unit Purchased/Referred Care (PRC) manager on matters involving PRC services. The incumbent does not appear to be responsible for, or authorized to act as a member of Agency management. The incumbent does not appear to have authority or responsibility for independently determining Agency policies related to their activities. Additionally the incumbent does not supervise other employees; does not perform duties involved with labor relations issues that would qualify the incumbent as a confidential employee; does not perform duties that would qualify as personnel work; does not perform duties that would be considered “security work” as defined by 5 USC § 7112 (b)(6) nor meet the requirements of FLRA to be considered “security work” for the statute; and does not perform duties involved with internal auditing functions.

Article 2 of the Collective Bargaining Agreement effective February 25, 2011, has included…