This position is located in the Financial Management Services at Gallup Indian Medical Center, in Gallup, NM. The purpose of the position is to administer the provision of Purchased Referred Care in compliance with regulatory requirements to determine patient's PRC eligibility, defining and interpreting PRC regulations and guidelines and maintaining records. Employee identifies and assists patients who may be eligible for coverage by third party resources.

Duties

Verifies and determines patient's eligibility for Medicare, Medicaid, Private Insurance, VA or other potential alternate resources as appropriate, which are available and accessible to the individual. Prepares memoranda for correspondence for the reviewing appeals officer, identifies deficiencies and recommends appropriate course of action. Performs substantive research in the areas of medical documentation, administrative compliance, inquiries and reports of investigation and standards of conduct/ethics Conducts in-depth face-to-face interview or by telephone with patients and/or families to ensure accurate completion of enrollment application. Obtains copies of verification of household income or other source of documentation, requests all other income and assets in documentation format from beneficiary and anyone in the household. Initiates medical authorizations and denial of service for inpatient/outpatient/ancillary medical services for eligible IHS beneficiaries. Investigates and analyzes controversial issues. Issues correspondence to patients, health care providers and other agencies regarding eligibility, IHS policy and regulations, including letters of denial of payment where the requirements of the IHS Program are not met. Tracks all referrals to non-IHS facilities to include those referrals to other IHS facilities to support the Case Management activities and continuity of care efforts. Participates in the weekly Case Management meetings, takes minutes and prepares the minutes for record and reporting purpose.

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-06: 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: interpreting and applying private sector and government program regulations to assure procedures are properly applied for programs such as, Purchase Referred Care, Medicare and Medicaid; registering patients in various Healthcare/Health Insurance programs; effective oral and written communication. 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: interprets and applies private sector and government program regulations to assure procedures are properly applied for programs such as, Purchase Referred Care, Medicare and Medicaid; conducting in-depth patient interviews to determine eligibility for alternate health insurance resources; registering eligible patients in various programs; resolving a wide range of problems and make appropriate decisions. GS-08: 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: interprets and applies private sector and government program regulations to assure procedures are properly applied for programs such as, Purchase Referred Care, Medicare and Medicaid; conducting in-depth patient interviews to determine eligibility for alternate health insurance resources; registering eligible patients in various programs; use of medical terminology; effective oral and written communication; fiscal coding procedures; accountability of funds; resolving a wide range of problems and make appropriate decisions. 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 Gallup Service Unit 516 E Nizhoni Blvd P O Box 1337 Gallup, NM 87301 US
• Name: Navajo Area IHS Human Resources
• Email: [email protected]