This position is organizationally located in the Indian Health Service (IHS) Purchased/Referred Care (PRC) Branch of the Great Plains Area Office in Aberdeen, South Dakota. The incumbent shares responsibilities for program planning, program development, management, operation, and evaluation of a comprehensive area PRC program. The incumbent performs difficult and complex assignments which are area-wide in scope and encompass a variety of program activities.

Duties

Assists with managing the overall Area PRC program. Develops, coordinates, and integrates operational plans in accordance with approved policies and directives pertinent to the administration and management of the are PRC and alternate resources program. Monitors the PRC spending plan, fund status reports and submits written requests for supplemental PRC funds, including budget information for congressional hearings. Reviews, analyzes, and summarizes pertinent financial, statistical, and program data. Provides consultation on proper billing procedures, interpretation of guidelines, verification of claims, appropriateness of services, and irregularities in billing information received.

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): OPM Link: Health System Administration Series 0671 (opm.gov) In addition to the Basic Requirements, you must also meet the Minimum Qualifications stated below. MINIMUM QUALIFICATIONS: GS-07: 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: 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 fiscal intermediary 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. GS-09: 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: 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 party programs ensure proper codes submitted to cover primary provider, diagnosis and clinic. Establish contacts with Fiscal Intermediary 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. GS-11: 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: experience in a managed care model of health care delivery service system that may include utilization review, pre-admission and current review and discharge planning; follow established policies and procedures of a Purchased Referred Care and Alternate Resource Program, determine if program is functioning efficient and effectively to meet established requirements; conduct onsite review to monitor and evaluate private contractor and facility program in the areas of health care, finance, contracting and administration which include coordination of benefits, medical service contracts and agreements; provide written findings and recommendations of review; review and resolve complaints and problems from customers who may have been denied services at the local level; monitor spending plans and financial transactions to ensure compliance with established guidelines. Establish contracts with fiscal intermediary companies to resolve claims, adjudication, and adjustments 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

There are no education requirements.

Contacts

• Address Great Plains Area 115 4th Avenue Southeast Aberdeen, SD 57401 US
• Name: Joseph Dudley
• Phone: 605-226-7203
• Email: [email protected]