This position is located in the Revenue Management Department at the Whiteriver Service Unit, Whiteriver, Arizona. The incumbent is responsible for all routine imports, exports, downloads are completed timely/daily and coordinated with the Department. Incumbent also serves as the technical resources for the varies department, Supervisors and Department Staff. Incumbent will report directly to the WRSU Revenue Manager, who is under the Administrative supervision.

Duties

Perform table maintenance to the Resource and Patient Management system (RPMS) revenue cycle package including, but not limited to, the provider file, fee schedule, insurer file, point of sale (POS), patient registration files. Serves as a technical resource to the billers, patient registration, PBC, accounts receivable staff including assisting with training, new patch downloads, table maintenance to packag4es, and any other computer application updates. Performs billing exports, ensuring that export batches are received and processed by the third party payers, following up on batches that are rejected with resolution to resolve problems, assisting the billing clerks with 5010 format, clearinghouse, eligibility and patient registration issues. Responsible for monitoring and evaluating PO processes, when necessary implements performance improvement monitors to identify problematic area with the Business Office as well as developing corrective action plan to alleviate issues from re-occurring, Perform other duties as assigned.

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): EDUCATION - GS-09 - Master's or equivalent graduate degree or 2 full years of progressively higher level graduate education leading to sucha a degree or LL.B or J.D., if related. GS-11: - Ph.D. or equivalent doctoral degree or 3 full years of progressively higher level graduate education leading to such a degree or LL.M., if related. In addition to the Basic Requirements, you must also meet the Minimum Qualifications stated below. MINIMUM QUALIFICATIONS: 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, such as: 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

This position has an education requirement. 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 https://sites.ed.gov/international/recognition-of-foreign-qualifications/.

Contacts

• Address White River Service Unit PO Box 860 White River, AZ 85941 US
• Name: Debbie Standing
• Phone: (928) 338-3561
• Email: [email protected]