This position is located in the Purchased Referred Care Department at Shiprock Service Unit, Shiprock, NM. The purpose of the position is to administer the provision of Purchased Referred care in compliance with regulatory requirements. Employee identifies and assists patients who may be eligible for coverage by third party resources.

Duties

Receives notification and referrals for non-IHS and IHS referred care through hard copy or the automated referred care system Verifies and determines patient's eligibility for Medicare, Medicaid, Private Insurance, VA or other potential alternate resources Researches matters thoroughly based on appropriate regulations or other mandatories prior to rendering work product Prepares memoranda for correspondence for the reviewing appeals officer, identifies deficiencies and recommends appropriate course of action Performs prescreening process for potential eligibility and gathers pertinent information utilized to determine PRC eligibility and potentially eligibility for alternative resources Conducts in-depth face-to-face interview or by telephone with patients and/or families to ensure accurate completion of enrollment application Ensures that PRC funds are available prior to issuance of obligating documents on behalf of the government Initiates medical authorizations and denial of service for inpatient/outpatient/ancillary medical services for eligible IHS beneficiaries Maintains complete fund control records for health services funds allotted Issues correspondence to patients, health care providers and other agencies Assures request for contracts are submitted with work specifications Tracks all referrals to non-IHS facilities to include those referrals to other IHS facilities to support Case Management activities

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: One (1) year of specialized experience equivalent to the GS-05 grade level. GS-07: One (1) year of specialized experience equivalent to the GS-06 grade level. GS-08: One (1) year of specialized experience equivalent to the GS-07 grade level. Specialized Experience Experience that equipped the applicant with the particular knowledge, skills, and abilities (KSA's) to perform successfully the duties of the position, and that is typically in or related to the position to be filled. To be creditable, specialized experience must have been equivalent to at least the next lower grade level. Applicants who have the 1 year of appropriate specialized experience are not required by this standard to have general experience, education above the high school level, or any additional specialized experience to meet the minimum qualification requirements. 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 at the GS-06 Level I have 1 year of specialized experience that equipped me with the particular knowledge, skills and abilities to successfully perform the duties of this position. This experience is related to the work of the position and equivalent to at least the GS-05 level in the Federal service as described in the vacancy announcement. Examples include: Retrieve, organize, and prepare medical records upon request. Scan documents. File reports and other pertinent information into the paper record in accordance with regulations. Perform routine clerical duties. Specialized experience at the GS-07 Level I have 1 year of specialized experience that equipped me with the particular knowledge, skills and abilities to successfully perform the duties of this position. This experience is related to the work of the position and equivalent to at least the GS-06 level in the Federal service as described in the vacancy announcement. Examples include: Knowledge in policy and regulations related to medical records confidentiality. Analyze and code medical records in automated record systems. File and purge inactive charts. Interact with personnel for corrective coding and data entry. Specialized experience at the GS-08 Level I have 1 year of specialized experience that equipped me with the particular knowledge, skills and abilities to successfully perform the duties of this position. This experience is related to the work of the position and equivalent to at least the GS-07 level in the Federal service as described in the vacancy announcement. Examples include: Provide information or rights and benefits of multiple alternate resources and advise patients of nonpayment or approval of claim. 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 Shiprock Service Unit Hwy 491 N PO Box 160 Shiprock, NM 87420 US
• Name: Navajo Area IHS Human Resources
• Email: [email protected]