The primary purpose of this position is to serve as a Lead Health System Specialist (PRC Technician Lead) with the Purchased Referred Care program. This position is located under the Indian Health Service, Mid-Atlantic Service Unit in Richmond, VA. The position will eventually be located with the Mid-Atlantic Tribal Health Center in Charles City, Virginia.

Duties

Conducts analysis of applicable policies and directives pertinent to the administration and management of the Purchased Referred Care program. Provides input for development and revision of operation, acquisition, and procurement plans and guidelines. Leads and provides guidance in patient registration, billing, benefit coordination and accounts receivables functions. Analyze and develop goals and projections for third party collection. Develop, prepare and analyze statistical reports for compliance with internal control requirements. Utilizes automated data processing equipment, electronic health records, UFMS and RPMS to achieve program goals. Lead revenue generation strategies in collaboration with business office and medical department staff. Verifies patient eligibilities with medical referrals, patient registration, and insurance billing verification. 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. 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: coordinates PRC, third party resources and funds reconciliation activities; trains and assigns work activities to staff, reviews, accepts/rejects work; leads in the implementation of principles of managed care; consults with executive staff for the appropriate use of PRC related to IHS direct care service; prepares operating procedures and quality improvement operations; recommends job description changes, performance standards, performance appraisals, etc., for staff; proficient in CHSMIS data system; monitors PRC funds and prepares reports that reflect status and utilization of resources. This definition of specialized experience is typical of work performed at the second lower grade/level position in the federal service (GS-07). OR Education: Master's or equivalent graduate degree or 2 full years of progressively higher level graduate education leading to such in a field which demonstrates the knowledge, skills, and abilities necessary to do the work of the position, such as: hospital administration, public health administration, or related fields such as business or public administration with course work in health care administration. (Note: You must attach a copy of your transcripts.) OR Combination of Education and Experience: A combination of education and experience may be used to qualify for this position as long as the computed percentage of the requirements is at least 100%. To compute the percentage of the requirements, divide your total months of experience by 12. Then divide the total number of completed graduate semester hours (or equivalent) beyond the first year (total graduate semester hours minus 18) by 18. Add the two percentages. (Note: You must attach a copy of your transcripts.) You must meet all qualification requirements within 30 days of the closing date of the announcement.

Education

If qualifying based on education alone, 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 Mid-Atlantic Service Unit 400 N. 8th Street, Rm G-63 Richmond, VA 23219 US
• Name: Nashville Area HR Inquiries
• Email: [email protected]