This position is located at the Phoenix Indian Medical Center (PIMC), Patient Business Services (PBS) Department, Third Party Billing, Accounts Receivable, and Claims Denial and Appeal Section in Phoenix, AZ. The incumbent is part of a team that is responsible for the examination, verification, and maintenance of data involved in processing, tracking, and generating alternate resources reimbursement and performing other related support duties.

Duties

Posts and batches payments received on a daily basis. Also follows-up on non-payments, adjustments, and refunds. Reviews all incoming correspondence determining whether the claim is final; more medical information is needed; claim needs to be resubmitted; or claim needs to be forwarded for appeal. Actively performs audits and medical reviews to ensure documentation and accountability of all health insurance claims submitted for payment by conducting random sample reviews. Communicates directly with third party payers on the eligibility of patients to ensure the information in the RPMS are correct to ensure accurate billing.

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. MINIMUM QUALIFICATIONS: GS-5: Your resume must demonstrate at least one year of specialized experience at or equivalent to at least the GS-4 grade level in the Federal service obtained in either the private or public sector; Examples include: batching and posting payments received from third-party payers & following up on non-payments, adjustments, and refunds. OR Completed 4 years of education above high school. (Transcripts Required) OR Possess a combination of education and experience that when combined fully meet the minimum qualifications for this position. The total percentage equals at least 100 percent to qualify for this GS-05 grade level. Notes: Only education in excess of the first 60 semester hours (i.e., beyond the second year) is creditable toward meeting the specialized experience requirement. One full academic year of study (30 semester hours) beyond the second year is equivalent to 6 months of specialized experience. GS-6: Your resume must demonstrate at least one year of specialized experience at or equivalent to at least the GS-5 grade level in the Federal service obtained in either the private or public sector. Specialized experience qualifying for the GS-6 grade is defined as: examining, verifying, and maintaining data involved in processing, tracking, and generating alternate resources reimbursement; researching denied claims; & filing all pending and completed claims and correspondence relative to third-party programs. GS-7: Your resume must demonstrate at least one year of specialized experience at or equivalent to at least the GS-6 grade level in the Federal service obtained in either the private or public sector. Specialized experience qualifying for the GS-7 grade is defined as: preparing monthly, quarterly, and annual reconciliation of third-party billing to assure that collections, billed data, and computerized & manual reports are in balance; performing audits and medical reviews to ensure accountability of all health insurance claims submitted for payment; & establishing day-to-day billing procedures for all third-party programs. 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).

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 Phoenix Service Unit 1616 E Indian School Rd Suite 360 Phoenix, AZ 85016 US
• Name: Jenny Vasquez
• Email: [email protected]