This position is located in the Business Office of the Rosebud IHS Service Unit. The functions of this position will include; 1) Prior Authorizations/Pre-Certifications; 2) Provider Enrollment; 3) Appeals; and 4) Accounts Receivable.

Duties

Works closely with the inpatient, surgery, outpatient, ancillary and various staff and third-party payers to obtain authorizations for services being rendered. Develops and maintains a system for monitoring services that require authorizations and to ensure the authorizations are completed in a timely and efficient manner. Works closely with credentialing, Staff Development Specialist, and Nurse Educator to enroll nursing and providers with South Dakota Medicaid, Medicare and Private Insurance Maintains a detailed tracking system for provider enrollment and gives weekly updates to supervisor. Works closely with Accounts Receivable and denials management.

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) 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: GS-9: One (1) years of specialized experience equivalent to at least the GS-7 grade level and/or 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. 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-9: Direct the activities of the Accounts Receivable and/or Denial/Accounts Management functions, perform long and short range planning, evaluation, and analysis; and projection of future resource requirements, personnel administration, provide training, development, and orientation of new and existing employees, and continuous quality improvement; Perform a variety of accounts receivable and denial/accounts management functions such as: examination, verification and maintenance of data involved in processing payments, denials and partial payments from alternate resources; determine the eligibility of patients; Identify and analyze issues, problems and challenges facing the revenue cycle management; Evaluate and compile data of denied claims and analyzes status reports for review to Management. 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 Rosebud Service Unit PO Box 400 400 Soldier Creek Road Rosebud, SD 57570 US
• Name: Joseph Dudley
• Phone: 605-226-7203
• Email: [email protected]