Washington, DC

U.S. Office of Personnel Management
Classification Appeal Decision
Under section 5112 of title 5, United States Code

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Carlos A. Torrico
Acting Classification Appeals and FLSA Claims
Program Manager
Agency Compliance and Evaluation
Merit System Accountability and Compliance


12/19/2017

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Date

Introduction

The appellant’s position is currently classified as Medical Support Assistant, GS-679-6, and is located in the Lakehurst Administration Department, Naval Branch Health Clinic (NBHC) Lakehurst, Naval Health Clinic Annapolis (NHCA), Bureau of Medicine and Surgery (BUMED), U.S. Department of the Navy (DON), in Lakehurst, New Jersey.  The appellant believes her position should be classified as a Health System Specialist, GS-671-9.  We have accepted and decided this appeal under section 5112 of title 5, United States Code (U.S.C.).

General issues

The appellant makes various statements about her agency’s evaluation of her position and compares her duties to higher graded positions classified in the Health System Specialist Series, GS-671, in Military Treatment Facilities (MTFs) in other agencies across the country.  In adjudicating this appeal, our responsibility is to make our own independent decision on the proper classification of her position.  By law, we must make that decision solely by comparing her current duties and responsibilities to OPM position classification standards (PCS) and guidelines (5 U.S.C. 5106, 5107, and 5112).  Since comparison to PCSs is the exclusive method for classifying positions, we cannot compare the appellant’s position to others that may or may not be properly classified, as a basis for deciding her appeal.  Because our decision sets aside all previous agency decisions, the appellant’s concerns regarding her agency’s classification review process are not germane to this decision.

The appellant believes her official position description (PD), number 14203, is not accurate because the duties have been simplified and do not reflect the level of her responsibilities.  She disagrees with the percentage of time assigned to her disease management duties, and asserts spending 85 percent versus 60 percent as stated in her PD.  Further, during our interview with the appellant, she stated she is no longer responsible for the closeout of referrals, as indicated on her PD, as this function has been assigned to contractor personnel at NHCA.  She also explained (and was confirmed by her supervisor), that since a nurse was hired to work in the Medicine Department, her referral responsibilities have declined.  Additionally, she asserts that although TRICARE functions were removed from the clinic (as indicated on her PD evaluation statement), she remains listed on the TRICARE website as Lakehurst’s TRICARE representative and continues to provide counseling information on rights, benefits, and other TRICARE program related questions when needed.  The Branch Clinic Director certified to the accuracy of the appellant’s official PD.  A PD is the official record of the major duties and responsibilities assigned to a position by an official with the authority to assign work.  A position is the duties and responsibilities that make up the work performed by the employee.  Classification appeal regulations permit OPM to investigate or audit a position and decide an appeal based on the actual duties and responsibilities currently assigned by management and performed by the employee.  An OPM appeal decision classifies a real operating position and not simply a PD.  This decision is based on the work currently assigned to and performed by the appellant.

Our fact-finding disclosed that the appellant’s PD is not completely accurate.  The PD describes duties she does not perform in relation to programmatic responsibilities not vested in her position, and which imply a higher level of difficulty and complexity than reflected in the work she performs.  Specifically, the appellant does not work with “clinical professionals and paraprofessionals to monitor metrics and to continuously improve the efficiency and effectiveness of assigned programs.”  She does not “present data to the Military Health System Population Health Portal (MHSPHP) Committee to develop appropriate strategies for improvement and assists in identifying and communicating potential gaps or areas of improvement to the committee.”  Also, we did not find the appellant is responsible for providing “outreach support services for the HEDIS Program.”  Further, the record does not support that her position requires maintaining a “highly detailed knowledge of medical conditions and diseases,” or using knowledge of “case management, utilization management and clinical data analysis.”  Moreover, under Factor 1, Knowledge Required by the Position, her work does not require that she “understand regulations and standards of various regulatory groups and be knowledgeable about government-wide agency and facilities system requirements…”  Therefore, the appellant’s PD of record does not meet the standard of adequacy addressed on pages 10-11 of the Introduction, and the agency must revise the PD to reflect our findings.

Position information

NHCA is within the Annapolis Area Naval Complex in Annapolis, Maryland.  The complex is composed of the U.S. Naval Academy, Naval Support Activity Annapolis and other tenant commands.  The mission of the NHCA is to optimize the health and readiness of the Brigade of Midshipmen, and Active and Reserve Forces.  The NHCA is the immediate superior in command of NBHCs in Philadelphia and Mechanicsburg, Pennsylvania; and Earle and Lakehurst, New Jersey.  The appellant’s position is located in the administration department of the NBHC Lakehurst.  The primary function of the NBHC Lakehurst is to provide quality primary medical care, dental care, occupational and industrial health services to active duty personnel of the Naval Air Engineering Station in Lakehurst, New Jersey.

The appellant’s primary responsibility involves providing administrative support for the Disease Management Program administered by the NHCA.  The position of Nurse Specialist (Disease Management), GS-610-12, serves as the program manager.  The program manager is responsible for developing, implementing, and evaluating activities related to disease management for the command and its NHBs.  The program aims to improve disease state outcomes of a targeted population of people with chronic medical illnesses (e.g., diabetes or depression), help the person to self-manage their disease by collaborating with their provider to ensure applicable screenings, tests or care are performed at appropriate intervals.  The program measures its effectiveness in care and services using Healthcare Effectiveness Data and Information Set (HEDIS) measures.  HEDIS measures cover many aspects of healthcare including preventive care, such as cervical and breast cancer screenings, and condition specific care, such as antidepressant medication management and diabetes care.

The appellant serves as the coordinator for the Disease Management Program at NBHC Lakehurst.  As such, she is responsible for identifying members who meet criteria (e.g., age and health history) for screening, testing or receiving care tracked by HEDIS measures.  This entails reviewing medical records, contacting members who are overdue or have not had the required screening, and providing them with information aimed at understanding the importance of disease prevention to encourage screening for diseases.  She coordinates care by scheduling appointments, obtaining and documenting test results into CarePoint, the facility’s healthcare application suite used to retrieve and capture HEDIS data for the program.  The appellant prepares monthly reports providing HEDIS performance percentiles reached by the MTF. 

The appellant is also responsible for submitting referrals for specialty care services not offered at the clinic (e.g., nutrition services for diabetics, dermatology).  She coordinates care related to referrals with NHCA, network providers and patients.  Additionally, as the onsite local representative for TRICARE, she provides assistance to TRICARE enrollees by answering questions related to TRICARE programs, their rights, benefits, assisting with billing problems, or other related matters, as needed.

In reaching our classification decision, we have carefully reviewed all information provided by the appellant and her agency including the official PD, which, although not completely accurate, we have incorporated by reference into this decision.  In addition, to help decide the appeal we conducted separate telephone interviews with the appellant and her supervisor (i.e., Clinic Manager) including follow-up requests for additional information from the appellant.

Series, title, and standard determination

The agency has placed the appellant’s position in the Medical Support Assistance Series, GS-679, titling it Medical Support Assistant, and evaluating it by application of the grading criteria in the Job Family Standard (JFS) for Assistance and Technical Work in the Medical, Hospital, Dental, and Public Health Group, GS-600.  The appellant disagrees with her agency’s title and series determination, and believes her position should be classified as a Health System Specialist, GS-671-9.

The Health System Specialist Series, GS-671, covers two-grade interval specialized administrative work that provides support to health care management officials by analyzing, evaluating, advising on and/or coordinating health care delivery systems and operations.  Such positions may be located within an operating health care facility or at a higher organizational echelon.  In addition to a high degree of analytical ability, positions in this series require specialized knowledge of the basic principles and practices related to the management of health care delivery systems.  These positions do not have line authority.  Qualifications for this type of position include:  knowledge of missions, organizations, programs, and requirements of health care delivery systems in general and in the country at large; knowledge of unique characteristics of the specific health care delivery system serviced (e.g., facility resources and programs, medical school affiliations, and the role of professional societies and volunteer groups); familiarity with regulations and standards of various regulatory and credentialing groups and ability to reconcile contradictory requirements in preparing staff recommendations and/or in coordinating clinical and administrative services; familiarity with government-wide, agency, and facility systems and requirements in various administrative areas such as budget, personnel, and procurement; recognition of the different functions and motivations of various employees and groups in the health care delivery system and ability to communicate effectively with each in order to gather information, present recommendations, and coordinate services; and ability to analyze problems and present both written and oral recommendations taking into full consideration the wide range of factors and requirements which affect the management of the health care delivery system.

The Medical Support Assistance Series, GS-679, covers one-grade interval administrative support positions that supervise, lead, or perform support work in connection with the care and treatment given to patients in wards, clinics, or other such units of a medical facility.  Employees in this series perform record keeping duties, determine patient eligibility for treatment and paid travel expenses, complete and route requests for patient activities and treatment procedures, receive and direct patients and visitors, answer routine questions, review patient documentation and files and record a variety of medical data; schedule appointments for patients with other medical services, and provide miscellaneous support to the medical staff of the unit to which assigned.  The work requires practical knowledge of computerized data entry and information processing systems, the medical facility’s organization and services, basic rules and regulations governing visitors and patient treatment, and a practical knowledge of the standard procedures, medical records, and medical terminology of the activity supported.  Medical Support Assistants are commonly considered chief sources of information and play an important role in accomplishing the role of the organization to which they are assigned.

In adjudicating this appeal, we must determine whether the appellant’s work is covered by an administrative or support series.  Some tasks are common to both administrative and support occupations, i.e., between assistants classified in one-grade interval administrative support occupations and specialists classified in two-grade interval administrative occupations.  Classification guidance in the Introduction and The Classifier’s Handbook describe the distinctions between positions properly classified in one-grade interval support series and two-grade interval administrative series. 

Support work usually involves proficiency in one or more functional areas or in certain limited phases of a specified program.  Normally a support position can be identified with the mission of a particular organization or program.  The work usually does not require knowledge of the interrelationships among functional areas or organizations.  Employees who perform support work follow established methods and procedures.  They may occasionally develop work plans or recommend new procedures, but these typically are related to the employee's individual assignment or immediate work unit.  Support work can be performed based on a practical knowledge of the purpose, operation, procedures, techniques, and guidelines of the specific program area or functional assignment.  Support personnel typically learn to do the work on the job and may also attend specific training courses related to their work.

Administrative work, on the other hand, primarily requires a high order of analytical ability combined with a comprehensive knowledge of (1) the functions, processes, theories, and principles of management; and (2) the methods used to gather, analyze, and evaluate information.  Administrative work also requires skill in applying problem solving techniques and skill in communicating effectively both orally and in writing.  Administrative positions do not require specialized education, but they do involve the type of skills (analysis, research, writing, judgment) typically gained through college level education or through progressively responsible experience.  Administrative work often involves planning for and developing systems, functions, and services; formulating, developing, recommending, and establishing policies, operating methods, or procedures; and adapting established policy to the unique requirements of a particular program.

Our fact-finding does not support placement of the appellant’s position in the GS-671 series.  According to the record, the primary purpose of the appellant’s position is to perform support work and coordinate care given to patients in connection with the disease management and referral programs.  Her work is limited to following established methods and procedures, and the problems she encounters are recurring and have precedents.  The paramount knowledge required to perform the work is knowledge of standard procedures, medical records, and medical terminology of the program supported.  Further, as indicated by the appellant’s supervisor, an employee in the appellant’s position would require some degree of HEDIS and TRICARE knowledge that could be gained from job experience, and recruitment sources would include individuals who can work independently and possess customer service skills.

The appellant’s position does not require applying the depth and breadth of analytical, research and writing skills indicative of administrative positions nor specialized knowledge of the basic principles and practices related to management of health care delivery systems as described above in the definition and qualifications for the GS-671 series.  Typical of support positions, she resolves questions or situations in conformance with established policies and procedures.  In contrast to administrative occupations, the appellant does not have to apply a high level of analysis or judgment to make the decisions on the information gathered to resolve a particular situation.  Due to the nature of the work, the appellant is not required to make decisions on the facility’s care or services based on her research.  Her work is limited to gathering patient data, coordinating tests or treatment for patients, documenting test results, and producing reports based on medical data (i.e., test date and results) captured.  We find the appellant’s work is typical of that classified in the GS-679 series and, therefore,  must be evaluated by applying the grading criteria in the JFS for Assistance and Technical Work in the Medical, Hospital, Dental, and Public Health Group, GS-0600, which covers that series.  As prescribed in the JFS, the basic title for work in the GS-679 series is Medical Support Assistant.

Positions in the Medical Support Assistance Series, GS-679, and the Medical Records Technician Series, GS-675, are both evaluated by application of the grading criteria in the JFS for Assistance and Technical Work in the Medical, Hospital, Dental, and Public Health Group, GS-0600.  Our review disclosed that in grading the appellant’s position the agency assigned factor-levels for Factor 4, Complexity, and Factor 5, Scope and Effect, that can only be applied when evaluating positions in the GS-675 series.  This resulted in the erroneous evaluation of the position.  Our evaluation of the grade level of the position is solely based on application of the grading criteria for positions in the GS-679 series as addressed below.   

Grade determination

The GS-0600 JFS uses the Factor Evaluation System (FES) in which factor-levels and accompanying point values are assigned for each of the nine factors, with the total then being converted to a grade level by use of the grade-conversion table provided in the JFS.  Under the FES, each factor-level description in a JFS describes the minimum characteristics needed to receive credit for the described level.  Therefore, if a position fails to meet the criteria in a factor-level description in any significant aspect, it must be credited at a lower level unless the deficiency is balanced by an equally important aspect that meets a higher level.  Conversely, the position may exceed those criteria in some aspects and still not be credited at a higher level.

Factor 1, Knowledge Required by the Position

This factor measures the nature and extent of information or facts that a worker must understand to do acceptable work and extent of the skills needed to apply this knowledge.  To be used as a basis for selecting a level under this factor, knowledge must be required and applied.

At Level 1-3, the highest level described in the JFS for medical support assistance work, employees use knowledge of, and skill in applying, a standardized body of rules, procedures, and operations of the medical facility services, medical terminology used in the facility, and procedures of each unit serviced.  Employees also apply knowledge of the facility’s automated and/or manual records system, and regulations, administrative policies, and professional service procedures applicable to a variety of issues.  Skill and knowledge applied at this level is sufficient to give instructions to patients and arrange appointments, assemble patients’ charts, record physicians’ orders, retrieve x-rays, laboratory reports, and other relevant patient data.  The employee organizes patient records to research records, extract medical information and review records for completeness, accuracy, and consistency with medical facility requirements.  They record data involving patient appointments, impatient admissions, and discharge and transfer information using the medical facility’s automated and/or manual records system.

The position meets but does not exceed Level 1-3.  Comparable to this level, the appellant applies practical knowledge of HEDIS measures and benchmarks, TRICARE programs, referral rules, scheduling procedures, and administrative policies of her department to perform her work.  She uses basic medical terminology when describing processes (e.g., breast cancer screening) and procedures (e.g., colonoscopy), and when providing patient education related to preventive and condition specific care.  Like Level 1-3, the appellant applies knowledge of various automated systems when performing disease management and referral duties.  For example, she uses the Armed Forces Health Longitudinal Technology Application (AHLTA), the facility’s electronic medical records system, the Composite Health Care System (CHCS), an appointment scheduling application, and CarePoint used to retrieve patient data and document HEDIS data.  Similar to this level, the appellant extracts medical information from automated systems, and reviews records for completeness, accuracy, and consistency with medical facility requirements in connection with the disease management program functions.  For instance, the colorectal cancer screening measure is used to calculate the rate of colon cancer screening among TRICARE enrollees, 50-75 years of age.  The appellant retrieves a list of patients meeting these benchmarks, reviews medical records to identify adults with the date of their most recently documented colorectal cancer screening, and identifies those who have not had a screening.  Similar to Level 1-3, she contacts patients and provides education about the importance and benefits of the screening.  If patients agree to comply with the measure (i.e., colorectal cancer screening), she gives applicable instructions and arranges the appointment.  Once the test has been completed, she obtains a copy of the results (e.g., laboratory results), and documents the event in CarePoint to capture the data.  Further, when making referrals she follows administrative and operating procedures to coordinate with NHCA, network providers and patients.

This factor is evaluated at Level 1-3 and 350 points are assigned.

Factor 2, Supervisory Controls

This factor covers the nature and extent of direct or indirect controls exercised by the supervisor, the employee’s responsibility, and the degree to which the work is reviewed.

At Level 2-3, the highest level described in the JFS, the supervisor makes assignments by defining the overall objectives, priorities, and deadlines and assists with unusual situations that do not have clear precedents.  Employees independently plan the work, resolve problems, carry out successive steps of assignments, and make adjustments using accepted standard operating procedures or practices.  They handle problems and/or deviations that arise in accordance with established policies, regulatory and administrative guidelines, directives, instructions, and accepted practices in the occupation.  The employee refers new or controversial issues to the supervisor for direction and/or assistance.  The supervisor reviews completed work for results achieved, technical soundness, and conformance with applicable regulations, policies, and requirements.

The position meets but does not exceed Level 2-3.  Like this level, the nature of the appellant’s work, combined with her extensive experience and knowledge of the disease management program, referral processes, and TRICARE programs, allows her to work independently with little or no day-to-day supervision.  Similar to Level 2-3, the supervisor assigns work by defining the overall objectives and priorities and the supervisor, a doctor, or NCHA staff are available to discuss unusual situations having unclear precedents.  This exceeds criteria for Level 2-2 where work is assigned with general instructions and parameters and is reviewed for accuracy.  Comparable to Level 2-3, the appellant is advised of new policies and procedures.  Similar to Level 2-3, although the appellant's supervisor does not review in detail the methods used by the appellant to complete her responsibilities, he is responsible for determining whether the appellant’s performance meets defined goals.  Like this level, the appellant’s work is reviewed for completeness, appropriateness and conformity to disease management, referral and TRICARE program requirements.

This factor is evaluated at Level 2-3 and 275 points are assigned.

Factor 3, Guidelines

This factor covers the nature of guidelines and the judgment needed to apply them.

At Level 3-2, employees use a number procedural and regulatory guidelines that specifically cover the assigned work.  They use judgement to identify and select, from a number of similar guidelines and work situations, the most appropriate guidelines, references, and procedures to apply when making minor deviations or adapting guidelines to specific cases.  They refer situations that do not readily fit instructions or other applicable guidelines to the supervisor or a designated employee for resolution. 

At Level 3-3, employees use guidelines that consist of a variety of technical manuals, medical facility regulations, regulatory requirements, and established procedures, that are not completely applicable to some of the work or have gaps in specificity.  Employees use judgment to adapt and interpret guidelines to apply to specific cases or problems.  The employee uses discretion and initiative to decide on the appropriate course of action to correct deficiencies and improve the reliability of the information.  The employee may, within the framework established by higher authority, develop approaches to apply to new regulatory requirements, or to adapt to new technology. 

The position meets Level 3-2.  Like this level, available guidelines provide sufficient information and guidance for the appellant to complete her work.  Guidelines include HEDIS technical specifications issued by the Defense Health Agency, referral management standard operating procedures, TRICARE program guidelines, preventive care information pamphlets or other written materials, and Navy policies and instructions.  Comparable to Level 3-2, the appellant must select the appropriate guidelines to apply to specific cases. For instance, HEDIS technical specifications used by the appellant define measures, target patient population, and identify the preferred and acceptable methods for screening.  The appellant uses these guidelines and benchmarks (e.g., age and health history) to extract a list of patients who meet the criteria for the HEDIS measure being tracked.  Like Level 3-2,  matters that require significant deviation from the guidelines are referred to the doctor for signature and approval.  For instance, if a patient would like to be seen by a female doctor, and the facility only has male doctors, the doctor must approve a referral to a different medical provider.

The position does not meet Level 3-3.  Unlike this level, the appellant has access to established policies, procedures and precedents that cover most aspects of her work.  The guidelines are directly applicable to particular functions, and the nature of her assigned duties present little opportunity for her to exercise judgment to deviate from, or adapt to specific cases.  For instance, in her disease management work, the technical specification provides her with the measures, the target population, and the screening test or care needed required for closing gaps and reaching HEDIS metric goals.  Her judgment is limited to offering preferred or alternative methods for screening as defined in the guidelines.,  For example, taking a complete colonoscopy satisfying the ten year requirement, or as an alternative administering a fecal immunochemistry test (FIT), satisfying the test requirement for 3 years.  Unlike Level 3-3, the appellant’s work does not require that she develop approaches for applying new regulatory requirements or adapting to new technology. 

This factor is evaluated at Level 3-2 and 125 points are assigned.

Factor 4, Complexity

This factor covers the nature, number, variety, and intricacy of tasks, steps, processes, or methods in the work performed; the difficulty in identifying what needs to be done; and the difficulty and originality involved in performing the work.

At Level 4-2, the only level described in the JFS for medical support assistance work, employees perform several related processes such as compiling, recording, reviewing, selecting, and interpreting medical data and information incidental to a variety of patient care and treatment activities.  Employees decide what needs to be done by choosing from various options that require recognition of and differences among a few easily recognizable alternatives.  They also respond to changing priorities that frequently depend upon the urgency of the situation, and the differences in medical information about each patient. 

The position meets but does not exceed Level 4-2.  Like this level, her work involves compiling patient lists based on specific criteria, recording patient data (i.e., test dates and results), and reviewing and interpreting medical data and information incidental to a number of HEDIS measures.  Comparable to this level, the appellant responds to changing priorities depending on differences in medical information about each patient.  For instance, to capture the rate of breast cancer screening among TRICARE Prime female enrollees 52-74 years of age during the last 27 months, the appellant retrieves patient lists meeting these criteria, and reviews medical records to determine if a screening has been performed within the past 27 months.  However, she must identify differences in medical information and exclude women, for example, having a history of bilateral mastectomy.  Like this level, the appellant decides what needs to be done by choosing from various options that require recognition of and differences among a few easily recognizable alternatives.  For example, for patients without a colonoscopy within 10 years, she must be able to recognize whether the patient has met the colonoscopy screening requirement through other alternative methods, such as having had flexible sigmoidoscopy or a CT colonography in 5 years, a FIT-DNA test in 3 years, or a Fecal Occult Blood Test annually.  

This factor is evaluated at Level 4-2 and 75 points are assigned.

Factor 5, Scope and Effect

This factor covers the relationship between the nature of the work (i.e., purpose, breadth, and depth of the assignments) and the effect of work products or services both within and outside the organization.

At Level 5-2, the highest level in the JFS for medical support assistance work, employees perform receptionist and general recordkeeping duties.  They give patients correct instructions on test preparation, diets, and procedural requirements, and properly recording physician’s orders.  The work affects the efficiency, accuracy and acceptability of further processes or services, including patient care.

The position meets but does not exceed Level 5-2.  Like this level and supported by the appellant’s performance standards, the appellant is expected to provide customer service to patients in person and/or by phone.  She provides patients with instructions and written materials relating to the screening or care provided;  responds to questions from TRICARE beneficiaries; and ensures all required forms and instructions are prepared when making referral requests to NHCA.  Comparable to Level 5-2, the appellant performs recordkeeping duties involving the input of specialty care referral records, medical results (i.e., laboratory results), or other documentation containing medical information into the Health Artifact and Image Management Solution (HAIMS), a data sharing application.  She ensures referral forms are prepared and forwarded to the appropriate services or offices for action.  She also follows-up with other center departments or MTFs to provide or obtain information, properly transfer documents, and schedule appointments for referrals.  Similar to this level, the appellant’s work affects the efficiency, accuracy, and acceptability of the data used to track disease management performance of the MTF through patient care.

This factor is evaluated at Level 5-2 and 75 points are assigned.

Factors 6 and 7, Personal Contacts and Purpose of Contacts

Personal contacts include face-to-face and remote dialogue (e.g., telephone, email, and video conferences) with persons not in the supervisory chain.  Levels described under this factor are based on what is required to make the initial contact, the difficulty of communicating with those contacted, and the setting in which the contact takes place.  These factors are interdependent.  The same contacts selected for crediting Factor 6 must be used to evaluate Factor 7.  The appropriate level for personal contacts and the corresponding level for purpose of contacts are determined by applying the Point Assignment Chart in the JFS for Factors 6 and 7.

            Personal Contacts

At Level 2, the highest level described in the JFS, contacts are with employees within the medical facility, but outside the immediate unit.  Some contacts may be with the general public in moderately structured settings.  Such contacts may include representatives from insurance companies, private physicians, other care providers, and individuals from other agencies or organizations seeking information.

The position meets but does not exceed Level 2.  Like this level, the appellant’s contacts are employees within and outside her immediate unit.  Contacts include the facility’s doctor, nurses, and other staff within the MTF, as well as NHCA program managers and contractor staff.   Moreover, her contacts include individuals outside her immediate unit such as patients, other care providers, and TRICARE program and claim representatives.

            Purpose of Contacts

At Level B, contacts are made to initiate and follow through on work efforts or to resolve operating or technical problems related to the treatment of patients and/or the maintenance of patient records.  Employees at this level influence or persuade individuals or groups working toward mutual goals and have basically cooperative attitudes.

At Level C, contacts are to influence, persuade, interrogate, or control people or groups.  The people contacted are unusually difficult to communicate with because of very poor physical and/or mental conditions and/or because they are easily excitable, irrational, fearful, skeptical, uncooperative, or dangerous.  Employees at this level must be skillful in approaching the individual or group in order to obtain the desired results.

The position meets Level B.  Comparable to this level, the purpose of the appellant’s contacts is to coordinate patient screenings, tests and/or referrals for specialty care treatment.  In her work with TRICARE, the purpose of her contacts it to obtain information to respond to issues relating to benefits or services.  For example, when patients come to her with a billing problem or inquiry, she contacts the TRICARE point-of-contact for providers to get the matter resolved. 

The purpose of the appellant’s contacts does not meet Level C.  Unlike Level C, where the contacts are unusually difficult to communicate with and are uncooperative or dangerous, the contacts the appellant works with are typically working toward the same goals and have cooperative attitudes.  Although she recommends actions to patients, this is done within specified program criteria and guidelines. 

By application of the Point Assignment Chart in the JFS, Factors 6 and 7 are evaluated at Level 2B and 75 points are assigned.

Factor 8, Physical Demands

This factor covers the requirements and physical demands placed upon the employee by the work assignment.

At Level 8-1, the work is mainly sedentary, but may require walking, bending, standing, and/or carrying of light items such as files and manuals.  The work does not require any special physical effort or ability.

At Level 8-2, the work requires some physical exertion such as prolonged periods of standing, bending, reaching, crouching, stooping, stretching, and lifting moderately heavy items such as manuals and record boxes.

Level 8-1 is met.  The appellant’s work is primarily sedentary, but may require some bending, walking, and standing when she is called upon to assist in different departments, such as when she assists in the absence of the nurse in the Medical Department.  Unlike Level 8-2, the work does not require prolonged periods of physical exertion or lifting of moderately heavy items.

This factor is evaluated at Level 8-1 and 5 points are assigned.

Factor 9, Work Environment

This factor considers the risks and discomforts in the employee’s physical surroundings and the safety precautions required.

At Level 9-1, the work area is usually an adequately lighted, heated and ventilated office or medical facility setting.  The work environment involves everyday risks or discomforts that require normal safety precautions.

At Level 9-2, the work environment involves moderate risks or discomforts that require special safety precautions e.g., exposure to contagious diseases.  Employees may be required to use protective clothing or gear such as masks, gowns, gloves, or shields.  Employees may work in close proximity to mentally disturbed patients, and consequently, there is a possibility of physical abuse.

Level 9-1 is met.  The appellant’s regular and recurring work is performed in an office setting that is adequately lighted, heated, and ventilated.  The work involves everyday risks or discomforts requiring normal safety precautions typical of a medical environment.  Unlike Level 9-2, the appellant is not required to use protective clothing or gear, and does not work in close proximity to mentally disturbed patients who would put her in danger of physical abuse, such as those typically found in a psychiatric hospital or ward.  

This factor is evaluated at Level 9-1 and 5 points are assigned.

Summary
Factors	Level	Points
Knowledge required by the position	1-3	350
Supervisory controls	2-3	275
Guidelines	3-2	125
Complexity	4-2	75
Scope and effect	5-2	75
Personal contacts/Purpose of contacts	2B	75
Physical demands	8-1	5
Work environment	9-1	5
Total		985

A total of 985 points falls within the GS-5 grade level point range (855 to 1,100) in the grade conversion table of the JFS.

Decision

The appellant’s position is properly classified as Medical Support Assistant, GS-679-5.

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