This position is organizationally located in the Purchased/Referred Care (PRC) Branch, Billings Area Office, Indian Health Service and works under the direct supervision of the PRC Branch Chief or designee.

Duties

Review and evaluate the effectiveness and efficiency of the Purchased Referred Care program at facilities serviced. Develop, coordinate and integrate operational plans in accordance with agency policies and directives pertinent to the administration and management of the Purchased Referred Care and Alternate Resources Program. Develop statistical data from reports and other sources for purpose to review, approve and recommend changes to the Purchased Referred Care operating budget at facilities serviced, Monitor Purchased Referred Care spending plan, fund status reports and submit written requests for supplemental funds. Ensure proper decisions assessed to determine eligibility criteria and denial letters.

Requirements

Qualifications

To qualify for this position, your resume must state sufficient experience and/or education, to perform the duties of the specific position for which you are applying. Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community; social). You will receive credit for all qualifying experience, including volunteer and part time experience. You must clearly identify the duties and responsibilities in each position held and the total number of hours per week. BASIC REQUIREMENT(S): Individual Occupational Requirements Undergraduate and Graduate Education: Major study -- hospital administration, public health administration, or related fields such as business or public administration with course work in health care administration. or Specialized Experience (for positions above GS-5): Progressively responsible analytical or administrative, or clinical management or supervisory experience in the health care field. This work may have been performed in an operating health care facility or a higher organizational echelon with advisory or directional authority over such facilities. Work must have involved a close working relationship with facility managers and analysis and/or coordination of administrative, clinical, or other service activities, and provided knowledge of the following: Missions, organizations, programs, and requirements of health care delivery systems; Regulations and standards of various regulatory and credentialing groups; and Government-wide, agency, and facility systems and requirements in various administrative areas such as budget, personnel, and procurement. In addition to the Basic Requirements, you must also meet the Minimum Qualifications stated below. MINIMUM QUALIFICATIONS: The following shows the amounts of education and/or experience required to qualify for positions covered by this standard. GS-7: One (1) full year of graduate level education or superior academic achievement or 1 year of specialized experience equivalent to at least GS-5. GS-9: Master's or equivalent graduate degree or 2 full years of progressively higher level graduate education leading to such a degree or LL.B. or J.D., if related or 1 year of specialized experience equivalent to at least GS-7. Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the next lower grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: Specialized Experience GS-7: Duties are of a trainee level, provide assistance to supervisor and staff in monitoring expenditures of services provided to beneficiaries; assist with explaining eligibility for services to beneficiaries; drafts correspondence and reports for manager and senior staff review; work with automated financial reporting systems. Establish contacts with private insurance companies to resolve claims, adjudication and adjustment of claims. Provide information orally in response to inquiries concerning status of claims, applications, cases, or other actions pending approval or resolution. Specialized Experience GS-9: Provide technical support and assistance to program staff and facility staff on matters involving oversight and management of various services, i.e., medical, surgical, dental and ancillary to eligible beneficiaries; perform high cost case management of expenditures to determine cases that may include catastrophic illnesses; advise and educate beneficiaries on eligibility of services; assist with monitoring of fund control and appropriate use of dollars spent on allowed services; audits claims processed for patient eligibility for third part programs ensure proper codes submitted to cover primary provider, diagnosis and clinic. Utilize Current Procedural Terminology (CPT) Codes and ICD-10- CM (International Classification of Diseases 10th revision Clinical Modification) for billing. Research and resolve problems, and posts payments, adjustments, denial codes, and non-payment collections. Establish contacts with private insurance companies to resolve claims, adjudication and adjustment of claims. Provide information orally in response to inquiries concerning status of claims, applications, cases, or other actions pending approval or resolution. Time In Grade Federal employees in the competitive service are also subject to the Time-In-Grade Requirements: Merit Promotion (status) candidates must have completed one year of service at the next lower grade level. Time-In-Grade provisions do not apply under the Excepted Service Examining Plan (ESEP). You must meet all qualification requirements within 30 days of the closing date of the announcement.

Education

If you are using education as a substitute for experience, you are strongly encouraged to submit a copy of your transcripts or a list of your courses including titles, credit hours completed, and grades. Unofficial transcripts will be accepted in the application package. Official transcripts will be required from all selectees prior to receiving an official offer.

Only attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education may be credited. Applicants can verify accreditation at the following website: https://www.ed.gov/accreditation.

If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. For further information, visit http://www.ed.gov/about/offices/list/ous/international/usnei/us/edlite-visitus-forrecog.html.

Contacts

• Address Billings Area Indian Health Service 2900 4th Avenue North Billings, MT 59101 US
• Name: Cindy Bedeau
• Phone: 406-208-2732
• Email: [email protected]