The purpose of this position is to verify patient eligibility for all third party resources at the Crownpoint Service Unit. The incumbent will report to the Supervisory Health System Specialist, Division of Administrative Services in Crownpoint, NM.

Duties

Verification of all third party resources and workers compensation for all registrations. Utilizes electronic eligibility system for those third party resources with electronic verification capability. Performs telephone verification for third party resources that do not provide electronic eligibility query. Maintains, Key-enters, updates and verifies all alternate resources data necessary for patient registration and admission and for accurate billing through the use of the RPMS Patient Registration System and electronic eligibility system. Places telephone calls to insurance companies for the insured to enroll dependents, such as newborns. Verifies that patient information related to third party beneficiaries and Medicare, Medicaid such as, insurance claim number, type of coverage, spelling of names, birth dates, and other demographic information are correct and corresponds to CHCF third party payment system and RPMS requirements. Works closely with the Patient Registration and facility staff in screening for potential eligible by assuring identification and utilization of all alternate resources available to the Indian population. Identifies, follow-up and processes information on those patients, whose health benefits are subject to prior approval or require pre-certification to determine the extent of health care for both inpatient and outpatient. Performs other related 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): GS-05: One (1) year of specialized experience equivalent to at least the GS-04 grade level; OR, Four (4) years above high school. 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: Experience in verification of all third party resources and workers compensation for all registrations. Utilizing electronic eligibility system for those third party resources with electronic verification capability. Maintaining, Key-entering, updating and verifying all alternate resources data necessary for patient registration and admission and for accurate billing through the use of the RPMS Patient Registration System and electronic eligibility system. Identifying types of coverage policyholders are entitled to, informs billing office on changes on insurance carriers with employers. Following up all pending verifications and works closely with families and agencies to see that the Indian patients are not discriminated against because of their dual role as a citizen and as an IHS recipient. 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 http://www.ed.gov/about/offices/list/ous/international/usnei/us/edlite-visitus-forrecog.html.

Contacts

• Address Crownpoint Healthcare Facility PO Box 358 Crownpoint, NM 87313 US
• Name: Navajo Area IHS Human Resources
• Email: [email protected]